Introduction

The anaesthetist has several roles in a cardiothoracic transplant programme. These include preoperative assessment of candidates for transplantation, management of the organ donor, intraoperative management and postoperative care of the recipient. Details of the general anaesthetic approach to patients undergoing pulmonary and cardiac surgery are outside the scope of this chapter, which will focus on the issues specific to lung and heart–lung transplantation.

Pretransplant assessment

Case selection criteria are well established (see Chapter 12) and most units use some type of proforma to collect data during the process of assessment for transplantation. This collates essential data including blood type and lymphocy-totoxic antibody screen, body size measurements, findings from the physical examination, data from haematological, biochemical and microbiological screening, together with radiological reports and the results of lung function and cardiac catheterization data.

The anaesthetic appraisal will be influenced by the type of lung transplant that is required (single lung, double lung, or heart and lung). This will be affected by the nature of the underlying cardiopulmonary disease as well as the approach of the individual transplant programme (see Chapters 13 and 14).

Previous thoracic surgery or vascular collaterals associated with Eisenmenger's syndrome increase the risk of a prolonged operation and of needing to transfuse large volumes of blood products with consequent haemodynamic instability and risk of renal complications. In the case of live-related donor lobe of lung transplantation, detailed case conferences are typical to discuss the implications for both the donors and recipient. The team may recommend delaying putting the patient on the active waiting list if the preoperative status can be optimized by further treatment.