Intrathoracic organ transplantation

Thoracic organ transplantation improves survival and quality of life in patients with severe and refractory end-stage heart or respiratory failure. Since the first human-to-human heart transplant in 1967 there have been huge developments in organ preservation, perioperative management and immunosuppression regimes; and outcomes have improved accordingly. As the population ages and medical therapies improve, the number of patients who survive long enough to be considered for transplantation is increasing. At the same time, the number of donor organs available is static, even decreasing in some countries (including the UK), and the average age of donors is increasing. The lack of organs suitable for transplantation is a significant cause for concern and makes it imperative that all available donor organs are optimized. In this article we will summarize the principles of heart and lung transplantation, with emphasis on patient selection and donor and recipient management, as outlined in the Intercollegiate Surgical Curriculum Programme (ISCP) cardiothoracic surgery syllabus.