Extracorporeal support as a bridge to lung transplantation

Allocation of grafts for lung transplantation has been directed in many countries to patients in life-threatening conditions. Advances in technology for extracorporeal devices led to new concepts and increased use for bridging to lung transplantation. Taking these two developments into account, it seems that bridging technologies are used more frequently around the world.

The durability of extracorporeal devices for some weeks was described in many institutional and case reports. The change in technology seems to open a new era of possibilities. Use of this new technology not only in bridge to transplant but also as a bridge to recovery in acute respiratory distress syndrome patients was published most recently. Current and future use of extracorporeal gas exchange as an alternative to mechanical ventilation appears in the literature. Use of low resistance membranes in patients with pulmonary hypertension was described as a new therapeutical option.

Bridge to lung transplantation is of increasing importance with new allocation systems and the increasing demand. New extracorporeal technologies address this demand with reliable function for some weeks. But these developments also raise ethical questions of how to use these new tools wisely individually and also collectively for the field of lung transplantation.