The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on living donor lung transplantation for end-stage lung disease.

As part of the NICE's work programme, the current guidance was considered for review in July 2009 but did not meet the review criteria as set out in the IP process guide. The guidance below therefore remains current.


Having a lung transplant from living donors instead of from someone who has just died (a cadaveric donor) may be a possibility. Transplants from living donors may be an option for patients who cannot get one from someone who has died. It may also be a possibility for patients who are getting worse so quickly that they are likely to become too ill to have a transplant while they are waiting for a cadaveric donor.

A transplant from a living donor may also be an option for critically ill children because, for them, there is a particular shortage of suitable donors who have died.

A transplant from living donors usually involves three operations, one on each of two donors and one on the recipient. The lower lobe of the right lung is removed from one donor and the lower lobe of the left lung is removed from the other donor. Both lungs are then removed from the recipient and are replaced by the lung implants from the donors in a single operation.

For the operation on the recipient the doctor makes an opening in the chest. While the main procedure is being done the recipient?s circulation is connected to a heart-lung machine (cardiopulmonary bypass). This machine does the work of both the heart and the lungs, pumping the blood around the body and supplying it with oxygen. The doctor removes the diseased lungs and then implants the donated lobes one after the other.

Coding and clinical classification codes for this guidance.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.