Transplantation of the heart and both lungs is being considered as a clinical possibility in several surgical centres today. This paper reviews the experimental development of surgical techniques in this field. In the 1940s Demikhov in the U.S.S.R. succeeded in developing a technique by which he could carry out cardiopulmonary transplantation without the use of any artificial means of recipient support during the procedure. He obtained survivors for up to six days; late deaths occurred mainly from pulmonary complications. The techniques and results of subsequent workers using hypothermia or pump-oxygenator support are reviewed. Recent work has focused on the problem of the return of spontaneous respiration following denervation of the lungs which, of necessity, occurs during this procedure.
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