Lung transplantation has become a well-established treatment for a variety of end-stage pulmonary diseases. Silicosis is a rare indication for lung transplantation; however, there is currently no other treatment available for the disease in its end stages. This case study presents a 52-year-old man who presented with silicosis for lung transplantation. His in-hospital recovery journey is examined and discussion is provided about his experience of complications, including type 2 respiratory failure and non-compliance with non-invasive ventilation therapy. The patient education and support provided, particularly related to medication management following transplantation surgery, if of key importance during the transplant recipient’s recovery. The social situation and its implications for both the patient and their family should also be considered. Both these aspects are also explored in the context of the case presented.

The DonateLife Audit (DLA) is undertaken at Liverpool and Royal Prince Alfred (RPA) hospitals to measure and report on actual and potential organ donation activity. This includes all patient deaths in the intensive care unit (ICU) and emergency department (ED); and, patients with a neurological condition who died within 24 hours of discharge from ICU or ED. A death review committee was established in RPA in mid-2014 and Liverpool in mid-2017 to analyse all in-hospital deaths to determine whether these hospitals were missing potential organ donors beyond the DLA parameters.

The two death review committees analysed 12 months of data for comparison. The findings showed that both hospitals have a low rate of potential organ donors who died from non-neurological conditions. It also highlighted a significant number of unsupportable patients who presented in extremis in Liverpool and a significant number of patients with no suitable organs in RPA. It can be inferred that these limit the potential donor pool and therefore further exploration of these phenomena is warranted.