CPT® Code 32850

1. Indications

The donor pneumonectomy procedure, as described by CPT® Code 32850, is indicated for the procurement of lungs from a cadaver donor who is brain-dead. This procedure is typically performed when there is a need for lung transplantation due to various conditions affecting the recipient's lung function. The following are the explicit indications for performing this procedure:

• Brain Death The donor must be a brain-dead patient, which is a critical requirement for organ donation.
• Transplantation Needs The lungs are harvested to be transplanted into a recipient suffering from end-stage lung disease or severe respiratory failure.
• Compatibility The donor lungs must be compatible with the recipient in terms of size, blood type, and other immunological factors to ensure successful transplantation.

2. Procedure

The procedure for donor pneumonectomy involves several critical steps that ensure the successful removal and preservation of the lungs for transplantation. Each step is essential for maintaining the viability of the organs:

• Step 1: Incision and Access A long incision is made in the chest to open the thorax, providing access to the thoracic cavity where the lungs and heart are located. This step is crucial for the subsequent dissection and removal of the organs.
• Step 2: Dissection of Vessels and Trachea The great vessels, including the aorta and the superior and inferior vena cavae, along with the trachea, are carefully dissected free from surrounding tissues. This meticulous dissection is necessary to ensure that the organs can be removed without damage.
• Step 3: Administration of Heparin Systemic heparin is administered to prevent clotting during the procedure. This anticoagulant is vital for maintaining blood flow and ensuring that the pulmonary vasculature can be effectively flushed.
• Step 4: Cannulation and Flushing The pulmonary arteries are cannulated, allowing for the flushing of the pulmonary vasculature with a cold preservation solution. This step is critical for preserving the lung tissue and preparing it for transplantation.
• Step 5: Stopping Heart and Respiration The heart and respiration of the donor are intentionally stopped to facilitate the removal of the organs. This is a necessary step to ensure that the organs can be harvested without further physiological activity.
• Step 6: Division of Vessels and Trachea The superior and inferior vena cava, the aorta, and the trachea are divided, allowing for the complete removal of the heart and lung block. This step is essential for ensuring that the organs are removed cleanly and efficiently.
• Step 7: Removal of Heart and Lungs The heart and lung block are removed from the thoracic cavity. The heart is then separated from the lungs, along with the attached portions of the superior and inferior vena cavae and the aorta. This separation is crucial for preparing the lungs for preservation.
• Step 8: Preservation and Transport The harvested lungs are placed in a crystalloid solution, packed in ice, and transported to the recipient transplant site. This preservation method is vital for maintaining the viability of the lungs until they can be transplanted into the recipient.

3. Post-Procedure

After the donor pneumonectomy procedure, the harvested lungs are carefully packed in ice and placed in a crystalloid solution to ensure their preservation during transport. The lungs must be delivered to the recipient transplant site as quickly as possible to maintain their viability for transplantation. It is essential that the transportation process is conducted under strict protocols to minimize any potential damage to the organs. Additionally, the surgical team must ensure that all documentation related to the donor and the procedure is completed accurately to facilitate the transplant process and maintain compliance with regulatory standards.