Question:

Can a lung transplant be done without blood? Is there anywhere in Australia that does it? Can you use your own blood, drawn before surgery? Or can a blood salvage machine be used? Thank you.

Answer:

You actually pose four questions! I will attempt to outline potential needs for blood in the transplant operation and then whether these can be avoided.

Bloodless cardiovascular surgery has been undertaken successfully. In general, there are at least three areas where blood and/or blood products may be needed in the transplant operation:

1) To “prime” a heart lung bypass machine
2) To replace normal blood loss from the operation or bleeding
3) To replace blood loss from difficult or complicated operations In addition to blood however, platelets or clotting factors may also be required although not all the time.

The following discussion is grouped by point above.

1) The type of operation needed, heart and lung function and diagnosis will dictate whether a bypass machine is needed or not. If the operation can be done “off-pump” so to say, this need for blood is obviated. If bypass is required, a variable amount of blood may be needed depending on the institutional practices. It is possible under some circumstances to undergo cardiopulmonary bypass without extra blood. Most cardiopulmonary bypass however is carried out in the presence of some blood thinner, which increases the likelihood of bleeding.

2) A certain amount of bleeding will occur from the routine conduct of surgery. Much of this blood within the chest can be salvaged and returned to the patient using “cell-saver” technologies. Certainly all surgeons attempt to minimize routine blood loss.

3) The complication of bleeding may occur during every surgery. Major bleeding is uncommon but possible during lung transplantation due to a variety of possible but rare events. These needs cannot be predicted. If they occur, blood and blood products over and above what can be conserved may be required and lifesaving. The use of one’s own blood which is stored prior to planned surgery has been described and is well known. Stored blood has a limited shelf life of approximately 6 weeks.

Unfortunately, lung transplantation cannot typically be planned and thus is often not amenable to storing one’s own blood which may need to be thrown away if not used for 6 weeks from collection. Lung transplantation without transfusion can theoretically be done but is rarely planned to be so. If the beliefs or wishes of the patient do not allow any blood or products to be used, there is a finite additional risk of surgery which might be significant given the particular case. This risk needs to be assessed on a case by case basis. Whether a center feels that, they can offer “bloodless lung transplant” depends on factors like:

-the center,
-operation
-expected surgical risk among others.

Assessment of transplantation and issues surrounding the possibility of “bloodless” surgery should be discussed with your transplant center. To my knowledge, there are five centers which perform thoracic transplantation in Australia. Information about the number of surgeries and location can be gotten online from a variety of sources including the Australian/New Zealand Transplant Registries. (http://www.anzcotr.org.au)

For more information:

Go to the Lung Transplantation health topic.