The patient is anesthetised. When the donor organs arrive, they are checked for fitness; if any organs show signs of damage, they are discarded and the operation cancelled. Once suitable donor organs are present, the surgeon makes an incision starting above and finishing below the sternum, cutting all the way to the bone. The skin edges are retracted to expose the sternum. Using a bone saw, the sternum is cut down the middle. Rib spreaders are inserted in the cut, and spread the ribs to give access to the<unk>  and lungs of the patient. The patient is connected to a<unk><unk> lung machine, which circulates and oxygenates blood. The surgeon removes the failing<unk>  and lungs. Most surgeons endeavour to cut blood vessels as close as possible to the<unk>  to leave room for trimming, especially if the donor<unk>  is of a different size than the original organ. The donor<unk>  and lungs are positioned and sewn into place. As the donor organs warm up to body temperature, the lungs begin to inflate. The<unk>  may fibrillate at first<unk>  this occurs because the cardiac muscle fibres are not contracting synchronously. Internal paddles can be used to apply a small electric shock to the<unk>  to restore proper rhythm. Once the donor organs are functioning normally, the<unk><unk> lung machine is withdrawn, and the chest is closed.
Heart–lung transplant
Portacaval shunt
Lung transplantation
Atriocaval shunt
Ventriculectomy
Arterial switch operation
Artificial lung
Pulmonary tractotomy