Lung transplantation: Report of the ATS workshop on lung transplantation

This workshop has identified several factors associated with enhanced success, some major gaps in knowledge, and some unresolved issues in the field of lung transplantation. A summary of the most salient points is provided below. What are the Facts about Lung Transplantation? Improvements in donor and recipient selection, in immune suppression, and in surgical techniques have collectively led to enhanced survival. There has been an expansion in the number of diseases for which lung transplantation is a therapeutic option. There has been considerable expansion in the number of clinical programs performing lung transplants. There remains a very limited pool of donor organs and long waiting times for potential transplant recipients. What Additional Knowledge Is Needed? Better definition of the role of histocompatibility antigens in successful engraftment. Development of optimal methods of preserving cadaveric donor lungs. Better definition of the optimal window for transplantation for various diseases. Definition of the long-term outcome of single lobe transplants in pediatric patients. Improved methods to prevent, differentiate, diagnose, and treat rejection, infection, and obliterative bronchiolitis. Determination of the full range of diseases for which lung transplantation can be considered an appropriate therapeutic option. Long-term outcome in single versus double lung transplantation. What Issues Remain Unresolved? At present, lung transplantation is not considered part of the usual and customary repertoire of procedures uniformly covered by public and private health insurance. As a result, the recipient population is restricted largely to those with a private insurance and cases considered as special exceptions under federal financing programs. The potential for increasing the limited pool of donor organs through expanded use of living donor lobes poses ethical and clinical concerns. A series of issues is brought into play when any procedure evolves from the research to the clinical setting. Lung transplantation is no exception and the same dilemmas apply, including: For whom will this procedure be available? What are the ethical criteria in the procurement of tissue? How do transplantation needs relate to donor availability? When is it cost-effective? What social burden will this place on public and private financing of care?