The current status of lung transplantation.

The supply of donor organs remains extremely limited and improved methods to maintain the lungs of potential donors to allow for transplantation must be developed. Improved methods for preservation will increase the supply of suitable lungs and considerably simplify the logistics of transplantation, just as has occurred with liver transplantation. In the meantime, we continue to strive to utilize donor organs in the most efficient manner. On four occasions within the past 5 months, we have performed two simultaneous single lung operations and are prepared either to do this as a routine, or to offer the other lung to another center. Sufficient progress has been achieved to date to warrant the continued application of lung transplantation for end-stage pulmonary disease. With increasing experience, one can anticipate refinement of techniques and broader application of these procedures. Single lung transplantation, initially restricted to patients with end-stage pulmonary fibrosis, now has been applied successfully to patients with emphysema, pulmonary hypertension, and other conditions. We anticipate offering lung transplantation in the pediatric and even neonatal population in the very near future. This may prove to be particularly important in the group of children with so-called bronchopulmonary dysplasia, an end-stage interstitial fibrosis occurring in a small percentage of children born with what initially appears to be hyaline membrane disease and who require prolonged mechanical ventilation. Though currently transplantation can offer real benefit only to a limited number of individuals, it serves to create hope for many others. An additional benefit may prove to be the interest and attention that transplantation focuses on patients with end-stage lung disease and on the pathophysiology of chronic respiratory failure. Knowledge gained ultimately may result in the prevention of many of the disorders for which lung transplantation currently offers the only hope.