Lung transplantation is a life-extending treatment for individuals with end-stage lung disease, typically relying on organs from deceased donors. Living lung donation is medically possible, but it is an extremely rare and complex procedure compared to other living organ donations, such as a kidney or a portion of the liver. This procedure involves substantial risk to the donor and is reserved for highly specific, urgent situations when deceased donor lungs are unavailable or unsuitable.
The Medical Feasibility of Living Lung Donation
Unlike the liver, which can regenerate after a partial donation, the lungs do not possess this ability, meaning any removed tissue represents a permanent loss of lung capacity for the donor. The standard approach for a living lung transplant involves procuring a lobe, which is one of the five sections that make up the two lungs. Because a single lobe is insufficient to sustain the recipient, this type of transplant requires two separate living donors, each contributing a single lower lobe to the recipient.
This procedure carries a significant risk to the two healthy donors, making it a last-resort option in most Western transplant centers. Deceased donor lungs remain the standard of care globally, and living donation is typically considered only when a patient is facing a very limited survival window. The logistics of coordinating two healthy, consenting donors for one recipient adds to the procedure’s complexity. Living donor lung transplantation (LDLT) is more commonly performed in regions where the supply of deceased donor organs is severely limited, such as in Japan.
Strict Criteria for Donor Eligibility
The screening process for a potential living lung donor is rigorous, reflecting the seriousness of the surgery and the permanent nature of the donation. Candidates must be in excellent physical health with no history of smoking or underlying chronic diseases. Comprehensive pulmonary function tests are mandatory to ensure the donor retains sufficient respiratory capacity to live a normal, healthy life post-donation.
Beyond physical health, a thorough psychological evaluation is conducted to ensure the donor provides fully informed and uncoerced consent. This assessment confirms the donor understands the considerable risks and the long-term impact on their exercise tolerance. Logistical requirements are also strict, including blood type compatibility, an appropriate size match between the donor’s lobe and the recipient’s chest cavity, and a confirmed motivation for donation. Typically, the two required donors are close relatives, such as parents or siblings, given the high level of commitment and compatibility necessary for the procedure.
The Surgical Procedure and Donor Recovery
The surgical procedure for the living donor is a lobectomy, which involves the removal of a lower lobe from one lung. Each of the two donors undergoes this separate operation concurrently with the recipient’s transplant surgery. The precision required for the lobectomy is high, as the surgeons must carefully detach the lobe while preserving the necessary blood vessels and airways for implantation.
Immediate post-operative recovery for the donor involves a hospital stay, often lasting one to three weeks. Pain management is necessary for the incision site, and early mobilization is encouraged to prevent complications like blood clots. The overall recovery timeline for a donor to return to normal activities typically ranges from several weeks to a few months.
The long-term impact on the donor is a permanent reduction in total lung capacity, as the remaining lung tissue does not fully compensate for the removed lobe. While most donors can resume a healthy lifestyle, they may experience a noticeable reduction in exercise tolerance, particularly during intense physical activity.
Recipient Scenarios Where Living Donation is Used
Living lung donation is pursued only for recipients facing an immediate, life-threatening situation where deceased donor options are not viable. Historically, the procedure gained prominence for treating pediatric patients, especially those with cystic fibrosis. Finding a size-matched deceased donor lung for a small child is exceptionally difficult, and the urgent need for a transplant often cannot wait.
For recipients with severe, rapidly progressing lung diseases, a living donation offers the advantage of a planned, immediate procedure. This is particularly relevant when the recipient has an active infection that might disqualify them from receiving standard deceased donor lungs. Transplanting two healthy lobes from living donors provides a timely bridge to survival that the standard deceased donor waiting list cannot guarantee.