Donor selection and management

Major technical and pharmacological advances mean that lung transplantation (LTx) now offers a realistic opportunity for long-term survival in selected patients with endstage pulmonary disease [1, 2]. Unfortunately, up to 50% of patients identified as suitable candidates to undergo LTx will die from their underlying lung disease before an organ becomes available [3, 4]. The severe shortage of donor organs is now the major limitation for use of the procedure as a widely available therapeutic option. Although a number of strategies are being developed and refined to provide donor lungs or lobes from alternative sources such as nonheart-beating donors or living lobar donation, a majority of lungs will have originated from ventilated brain-dead patients, whose relatives had given consent for organ donation. Multiple strategies have been adopted by the transplant community to increase the number of donor organs for all types of solid organ transplantation. Attempts at raising awareness in medical staff to identify potential brain-dead donors and in the general public to encourage consent when approached, has failed to dramatically increase the number of organs available for transplantation. Despite 25% of the UK public carrying a donor card, both emotional and cultural reasons within families have prevented this leading to a significant increase in donors. In other countries, legislation requiring medical staff to approach all potential donor families and the introduction of an "opt out" rather than "opt in" system of donation have not resulted in a major increase in the donor pool [5]. In 1989, a national transplant organisation was created within the Spanish Department of Health. In 1998, it demonstrated an increase in the average rate of organ donation from 14 per million population to 31.5 per million population by establishing a network of transplant coordinators with a sense of involvement and responsibility of accountability for performance [6]. Optimising the donor pool