[Lung Transplantation;Allograft and Xenograft]

Lung transplantation has been performed worldwide and recognized as an effective treatment for patients with various end-stage lung diseases. Shortage of lung donors is one of the main obstacles. Lung transplantation in the use of donation after cardiac death has now been increasingly performed in Europe and USA with promising results. However, controlled death is not permitted in Japan making it difficult to accept this strategy. Use of marginal donors is one of the strategies. In Japan, the rate of lung usage is now well over 60% owing to careful donor management by medical consultants and aggressive use of marginal donors. In 2010, Japanese transplant low was revised and the number of cadaveric lung donor has increased by 5 fold. However, the average waiting time is still more than 800 days resulting in considerable number of deaths on the waiting list. As a result, living-donor lobar lung transplantation is often the only realistic option for very sick patients.