Successful lung transplantation after prone positioning in an ineligible donor: a case report

Abstract

Atelectasis is a reversible factor in hypoxemia among brain-dead donors. In ineligible donors, prone positioning reverses atelectasis and improves oxygenation. We present a successful lung transplantation after salvaging a previously unviable lung. A 37-year-old woman presented with acute pontine hemorrhage that progressed to brain death. The initial partial pressure of oxygen (PaO 2 )/fraction of inspired oxygen (FiO 2 ) ratio of the donor’s lung was 342 mmHg. The PaO 2 /FiO 2 ratio dropped to 49 mmHg due to atelectasis. There was no improvement despite recruitment maneuvers, bronchoscopy, and chest percussion. After placing the donor in the prone position for four hours, electrical impedance tomography showed improved atelectasis. The donor did not experience hemodynamic instability. The lung was transplanted into a patient with Kartagener’s syndrome with situs inversus. The surgical procedure was uneventful. He was successfully weaned from the mechanical ventilator on the second-day post-transplantation and was discharged from the hospital after 4 weeks.

Imaging and Functional Imaging of the Lung

“…The finding lacked the confirmation of a randomized controlled trial Son et al (2021) Case report A lung donor after brain death Prone positioning using EIT acutely improved the oxygenation of a brain-dead donor's lungs with atelectasis.…”

Patient management for thoracic organ donor candidates: the lung transplantation team’s view

“…This procedure may also be employed to remove stagnant secretions that could potentially lead to atelectasis or inhalation injury. Higher PEEP combined with recruitment maneuvers or prone positioning may help reduce ventilation-perfusion mismatching and diffusion abnormalities, thereby increasing the P/F ratio [ 16 ]. Notably, the University Hospital Marqués de Valdecilla in Spain implemented a strict donor management protocol that significantly improved the lung utilization rate from 20% to 50% [ 17 ] ( Table 2 ).…”

Allocation of Donor Lungs in Korea

“…Currently, EVLP and DCD are not legal in Korea, and the use of marginal donors has increased by more than 50% [ 6 , 8 ]. EVLP is actively used in the United States and Canada to increase organ availability, and in some cases, organ quality is improved by using the prone position [ 12 - 14 ]. EVLP should be introduced to expand the pool of suitable donor lungs and reduce the average wait time of transplant candidates [ 15 ].…”