Combined heart-lung transplantation: Options for increasing the donor pool

Combined heart-lung transplant (HLT) peaked globally in 1989-1990 with a subsequent fall in case numbers; however, there has been a steady increase in the number of HLTs performed in the United States since 2014. Due to rising interests in HLT, there was a timely session on HLT at the International Society for Heart and Lung Transplantation 45th Annual Meeting and Scientific Sessions. The session highlighted a novel approach to reduce geographical limitations for donor organs using ex vivo normothermic perfusion, but it re-introduced historical complications associated with en bloc double lung transplantation and the tracheal anastomosis. To continue advancing care to patients with combined heart and lung disease, the cardiothoracic transplant community needs to address challenges for access to donor organs for HLT candidates through resolving logistical and distance issues and developing best practice using machine perfusion and temperature-controlled preservation strategies.