SYMPOSIUM ON LUNG TRANSPLANTATION—Foreword
Lung Transplantation: Where Are We Today?

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The Dismal Past Record.

—The first human lung transplantation procedure was performed in 1963 at the University of Mississippi by Dr. James Hardy.1 The recipient was a patient with squamous cell carcinoma in the hilum of the left lung. Because of severe emphysema, he was thought to lack the pulmonary reserve necessary to tolerate pneumonectomy. The lung allograft had been retrieved from a donor who had sustained a fatal cardiac arrest; it functioned well after transplantation and showed no evidence of rejection. The

A Turning Point.

—The Toronto Lung Transplant Group used a disciplined approach to solving many of the problems associated with lung transplantation. They built on the results of heart-lung transplantation and the concepts developed for heart transplantation at Stanford University. After a series of elegant laboratory studies, the Toronto group was able to achieve acceptable bronchial healing. Additionally, they established rigid criteria for the selection of recipients and emphasized the role of a

Continuous Improvement.

—Recent changes in lung transplantation are evident across the spectrum of the practice.4 Clearly, selection of patients is extremely important in optimizing the outcome after lung transplantation and in ensuring the appropriate use of the scarce donor organs. New information is continuing to affect the process of recipient assessment and selection. Some factors, such as bone mineral density, would not have been thought to be critical to decision making until recently. Other factors, such as

Shortage of Donor Organs.

—A discussion of transplantation today would be incomplete without mentioning the issue of donor organ shortage. At the end of 1995, 1,894 patients were on the waiting list for lung transplantation in the United States, whereas 871 lung transplantations were performed in the United States during the entire year of 1995. The discrepancy between available donors and potential recipients continues to grow, and the implications of this discrepancy are numerous. Certainly, responsible decisions must

Conclusion.

—The field of lung transplantation is evolving rapidly. The result is continued improvement in patient outcome. Lung transplantation has emerged from its technical phase and, in the words of Dr. Joel Cooper,7 gone from curiosity to commonplace. It has become established as accepted treatment for an increasingly large number of end-stage pulmonary diseases. It now faces the same challenges and problems as those encountered with other organ transplantations. Additional improvements should be

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