Reframing lung transplantation through a sustainability lens

PURPOSE OF REVIEW: Lung transplantation is conspicuously resource intensive, yet the carbon footprint of solid organ transplantation, and lung transplantation in particular, remains relatively unmapped. Moreover, there is growing evidence that climate change adversely affects lung transplant recipients, directly and indirectly. This review explores opportunities to integrate sustainable practices across the lung transplantation pathway, with the dual aims of reducing environmental impact and reducing recipient morbidity and mortality. RECENT FINDINGS: Published literature outlines mitigation strategies to reduce the drivers of climate change, and adaptation strategies to modify the hazardous effects of the climate crisis on healthcare services. Opportunities to create "green chains" of transplant care start with appropriate recipient and donor selection, with both elements optimised to maximise operative success and avoid donor organ discard. The peri-operative phase offers scope for decarbonisation via the reduction of anaesthetic gas emissions, green procurement, and waste reduction. In the post-transplant phase, enhanced recovery after surgery (ERAS) programmes feed into longer term surveillance and care delivery, with increasing opportunities for telemedicine and noninvasive allograft monitoring, to reduce travel-related emissions. SUMMARY: The co-ordinated adoption of low-carbon, sustainable practices within lung transplantation offers a meaningful opportunity to reduce environmental harm, enhance healthcare infrastructure and workforce resilience, and improve patient outcomes in a patient cohort vulnerable to climate change. Lessons can be drawn from the global surgery movement; however, it remains the responsibility of transplant practitioners to foster a culture of environmental advocacy and to implement systematic measurement and targets for climate change and health indicators.