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June 2, 1989, Vol 261, No. 21 >
ARTICLE | June 2, 1989

Unique Aspects of Heart and Lung Transplantation Exhibited in the 'Domino-Donor' Operation FREE

William A. Baumgartner, MD; Thomas A. Traill, MRCP; Duke E. Cameron, MD; James D. Fonger, MD; Irvin B. Birenbaum, CCP; Bruce A. Reitz, MD
[+] Author Affiliations

Reprint requests to Division of Cardiac Surgery, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21205 (Dr Baumgartner).


JAMA. 1989;261(21):3121-3125. doi:10.1001/jama.1989.03420210069018
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References

During the past 2 decades various refinements in heart and lung transplantation procedures have taken place. Improved preservation methods, new immunosuppressive medications, and advances in technical capabilities have allowed innovative procedures to be performed. In May 1987 the first "domino-donor" operation was performed in the United States. A 28-year-old man with cystic fibrosis and end-stage lung disease received the heart and lungs of an anonymous donor after he donated his heart to a 38-year-old man with end-stage ischemic cardiomyopathy. The technical and logistical aspects of this transplantation procedure are described herein. Other unusual features of this case that are discussed include heart-lung transplantation for a patient with cystic fibrosis, the use of cardiopulmonary bypass to allow lung procurement and transplantation across long distances, and the current role of heterotopic cardiac transplantation.

(JAMA. 1989;261:3121-3125)

REFERENCES

1 +
Baumgartner WA, Augustine S, Borkon AM, et al.  Present expectations in cardiac transplantation . Ann Thorac Surg . 1987;;43:585-590.
2 +
Reitz BA, Wallwork JL, Hunt SA, et al.  Heartlung transplantation: successful therapy for patients with pulmonary vascular disease . N Engl J Med . 1982;;306:557-564.
3 +
Pennington DG, Codd JE, Merjary JP, et al.  The expanded use of ventricular bypass systems for severe cardiac failure and as a bridge to cardiac transplantation . J Heart Transplant . 1983;;3:38.
4 +
Fraser CD Jr, Tamura F, Adachi H, et al.  Donor core-cooling provides improved static preservation for heart-lung transplantation . Ann Thorac Surg . 1988;;45:253-257.
5 +
Ladowski JS, Kapelanski DP, Toodori MF, et al.  Use of autoperfusion for distant procurement of heart lung allografts . J Heart Transplant . 1985;; 4:330.
6 +
Wallwork J, Jones K, Cavarrocchi N, et al.  Distant procurement of organs for clinical heart-lung transplantation using a single-flush technique . Transplantation . 1987;;44:654.
7 +
Baldwin JC, Frist WH, Starkey TD, et al.  Distant graft procurement for combined heart and lung transplantation using pulmonary artery flush and simple topical hypothermia for graft preservation . Ann Thorac Surg . 1987;;43:670.
8 +
Hardesty RL, Griffith BP.  Procurement for combined heart-lung transplantation: bilateral thoracotomy with sternal transection cardiopulmonary bypass, and profound hypothermia . J Thorac Cardiovasc Surg . 1985;;89:795-799.
9 +
Yacoub M.  Distant organ procurement for heart-lung transplantation . Transplant Proc . In press.
10 +
Robicsek F, Sanger PW, Taylor FH.  Simple method of keeping the heart 'alive' and functioning outside the body for prolonged periods . Surgery . 1963;;53:525.
11 +
Hardesty RL, Griffith BP.  Autoperfusion of the heart and lungs for preservation during distant procurement . J Thorac Cardiovasc Surg . 1987;;93:11.
12 +
Wahlers T, Haverich A, Fiequth HG, et al.  Flush perfusion versus cooling via extracorporeal circulation in heart-lung preservation . J Heart Transplant . 1986;;5:89.
13 +
Fraser CD Jr, Tamura F, Kontos GJ Jr, et al.  Evaluation of current organ preservation methods for heart-lung transplantation . Transplant Proc . 1988;;20:987-990.
14 +
Yacoub M, Khaghani A, Aravot D, et al.  Cardiac transplantation from live donors . J Am Coll Cardiol. 1988;;11:102A.
15 +
Cooper JD.  Lung transplantation . Ann Thorac Surg . In press.
16 +
Guthaner DF, Wexler L, Sadeghi AM, et al.  Revascularization of tracheal anastomosis following heart-lung transplantation . Invest Radiol . 1983;;18:520.
17 +
Barnard CN, Barnard MS, Cooper DKC, et al.  The present status of heterotopic cardiac transplantation . J Thorac Cardiovasc Surg . 1981;;81:433-439.
18 +
Scott J, Higenbottam T, Hutter J, et al.  Heartlung transplantation for cystic fibrosis . Lancet . 1988;;2:192-194.
19 +
Baumgartner WA, Williams GM, Fraser CD Jr, et al.  Cardiopulmonary bypass with profound hypothermia: an optimal preservation method for multiorgan procurement . Transplantation . 1989;;47:123-127.

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1 +
Baumgartner WA, Augustine S, Borkon AM, et al.  Present expectations in cardiac transplantation . Ann Thorac Surg . 1987;;43:585-590.
2 +
Reitz BA, Wallwork JL, Hunt SA, et al.  Heartlung transplantation: successful therapy for patients with pulmonary vascular disease . N Engl J Med . 1982;;306:557-564.
3 +
Pennington DG, Codd JE, Merjary JP, et al.  The expanded use of ventricular bypass systems for severe cardiac failure and as a bridge to cardiac transplantation . J Heart Transplant . 1983;;3:38.
4 +
Fraser CD Jr, Tamura F, Adachi H, et al.  Donor core-cooling provides improved static preservation for heart-lung transplantation . Ann Thorac Surg . 1988;;45:253-257.
5 +
Ladowski JS, Kapelanski DP, Toodori MF, et al.  Use of autoperfusion for distant procurement of heart lung allografts . J Heart Transplant . 1985;; 4:330.
6 +
Wallwork J, Jones K, Cavarrocchi N, et al.  Distant procurement of organs for clinical heart-lung transplantation using a single-flush technique . Transplantation . 1987;;44:654.
7 +
Baldwin JC, Frist WH, Starkey TD, et al.  Distant graft procurement for combined heart and lung transplantation using pulmonary artery flush and simple topical hypothermia for graft preservation . Ann Thorac Surg . 1987;;43:670.
8 +
Hardesty RL, Griffith BP.  Procurement for combined heart-lung transplantation: bilateral thoracotomy with sternal transection cardiopulmonary bypass, and profound hypothermia . J Thorac Cardiovasc Surg . 1985;;89:795-799.
9 +
Yacoub M.  Distant organ procurement for heart-lung transplantation . Transplant Proc . In press.
10 +
Robicsek F, Sanger PW, Taylor FH.  Simple method of keeping the heart 'alive' and functioning outside the body for prolonged periods . Surgery . 1963;;53:525.
11 +
Hardesty RL, Griffith BP.  Autoperfusion of the heart and lungs for preservation during distant procurement . J Thorac Cardiovasc Surg . 1987;;93:11.
12 +
Wahlers T, Haverich A, Fiequth HG, et al.  Flush perfusion versus cooling via extracorporeal circulation in heart-lung preservation . J Heart Transplant . 1986;;5:89.
13 +
Fraser CD Jr, Tamura F, Kontos GJ Jr, et al.  Evaluation of current organ preservation methods for heart-lung transplantation . Transplant Proc . 1988;;20:987-990.
14 +
Yacoub M, Khaghani A, Aravot D, et al.  Cardiac transplantation from live donors . J Am Coll Cardiol. 1988;;11:102A.
15 +
Cooper JD.  Lung transplantation . Ann Thorac Surg . In press.
16 +
Guthaner DF, Wexler L, Sadeghi AM, et al.  Revascularization of tracheal anastomosis following heart-lung transplantation . Invest Radiol . 1983;;18:520.
17 +
Barnard CN, Barnard MS, Cooper DKC, et al.  The present status of heterotopic cardiac transplantation . J Thorac Cardiovasc Surg . 1981;;81:433-439.
18 +
Scott J, Higenbottam T, Hutter J, et al.  Heartlung transplantation for cystic fibrosis . Lancet . 1988;;2:192-194.
19 +
Baumgartner WA, Williams GM, Fraser CD Jr, et al.  Cardiopulmonary bypass with profound hypothermia: an optimal preservation method for multiorgan procurement . Transplantation . 1989;;47:123-127.

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