Orthotopic heart transplant is recognized as the gold standard for the treatment of end-stage heart disease. However, there is a perennial shortage of donor organs. Left ventricular assist devices (LVAD) represent a revolutionary tool for temporizing heart failure that is refractory to medical management until a suitable organ becomes available. This review highlights the LVAD as a tool for bridging to transplant. The history of the LVAD and its use in heart transplantation is described, as well as the current indications for use in the general heart transplant candidate as well as for selected subpopulations. It also highlights the major complications of LVAD use, advancements in the field, and selected current controversies related to the LVAD as bridge-to-transplant therapy.
Part of the book: Heart Transplantation
Lung transplantation has become an increasingly important modality for the treatment of severe lung disease. From its inception, the procedure has been refined so that it now represents the standard of care for end stage respiratory failure. The widespread adoption of this treatment option, however, has brought into sharp relief the current organ donor shortage. In tandem with the explosion in lung transplant procedures, a number of support modalities have seen an expanded role. Perhaps one of the most versatile tools in the armamentarium of the pulmonary transplant surgeon is extracorporeal membrane oxygenation (ECMO). This powerful tool is being increasingly implemented in all stages of lung transplantation—from supporting the failing native organ as a bridging tool to transplantation, to stabilizing the patient intra-operatively during the transplant procedure, to rescuing the patient with severe primary graft dysfunction immediately post-transplant. A number of advanced techniques for the application of ECMO in order to optimize the pulmonary transplant procedure are gaining traction—and with ECMO’s expanded role in lung transplantation, so also has come a new set of technical and ethical challenges that must also be overcome.
Part of the book: Advances in Extracorporeal Membrane Oxygenation
Procurement of thoracic organs can be divided into two major categories- donation after brain death (DBD) or donation after circulatory determination of death (DCDD). In this section we will focus primarily on DBD, which is the commoner of these two or at times referred to as standard procurement. DCDD is a relatively new and promising field that has helped ameliorate donor shortage, aided by the latest advances in medical technology. However, DBD continues to be the major avenue of organ donation. There are several different combinations of thoracic procurement surgeries: heart, double lung, single lung/ 2-single lungs, heart-lung en bloc for transplantation, Double Lung procurement for Bronchial arterial revascularization, Heart and Lung procurement in DCDD donors with the OCS, NRP or Lungs for EVLP.
Part of the book: Organ Donation and Transplantation