Lung Transplant

A lung transplant is a surgery performed to remove a person’s diseased lung, which is then replaced with a healthy one from a deceased donor.

Yes, there are a few different types of lung transplants that can be considered.

• Single-lung or double-lung transplants in which either or one or both lungs can be replaced.
• Heart-lung transplant, when both the heart and the lungs need replacement because of permanent damage to both organs.
• Pediatric lung transplant for children with severe diseases such as pulmonary hypertension, pulmonary fibrosis, and cystic fibrosis with end-stage lung disease.

The donor lung usually comes from someone under the age of 65 who is brain dead but still on life-support. This is usually the result of some fatal accident the donor may have been in and it is only once all efforts to save their life have failed that organ donation becomes an option.

A lung transplant is a last resort method for treating patients with severe lung failure. Possible patients for lung transplantation have usually tried all other medical treatments. To be a potential candidate, you must fit these criteria and be physically and mentally capable of undergoing surgery and post treatments. You can’t be considered for lung transplantation if you continue to smoke or heavily abuse drugs and alcohol.  Even if you fit these criteria, your transplant team may decide you are still unfit for candidacy for several reasons, such as the existence of co-existing medical conditions that may be worsened by surgery or post medications.

Your doctor will refer you to a transplant center if he thinks you are a fit candidate for transplantation. During the evaluation, you will have a transplant team made up of surgeons, nurses, physical therapists, pulmonologists, and social workers that will evaluate you physically and psychologically.  The team will interview you and your family to determine whether a good support system is present. You will also be given a number of heart, lung, and other lab tests to determine your physical condition. These tests include but are not limited to: a 6-minute walk, EKG, Cardiac Catheterization, nuclear cardiology studies, electrocardiogram, echocardiogram, chest CT scan, blood work, bone density test, pulmonary function tests, and any others your team finds necessary to complete a thorough evaluation. Your financial resources will also be assessed to see if you meet the program requirements.

Once you are accepted into a transplant program you will be put on the national waitlist. While you wait for your transplant, you need to keep in good health. Follow all diet and exercise plans your transplant team recommends, take your medications, cease drinking alcohol and smoking, and see your pulmonologist on a regular basis. Optimizing and keeping up your health is essential to a successful surgery and a sure way to keep your name on the waitlist. You will also be given regular tests by your physicians while you wait. Make sure you keep active medical insurance and keep the hospital up-to-date on your current information. You should also give your transplant team a fast and efficient way to contact you if a lung becomes available. Be sure you can be contacted quickly wherever you go and be prepared in advance to get to the hospital on a moment’s notice.

In spring 2005, The United Network of Organ Sharing (UNOS) decided to change the way lungs were being distributed. The new policy gives a lung allocation score to each approved candidate over the age of 12. Your score reflects the severity of your illness and the predicted success of your surgery. It is calculated based on medical information gathered from lab values, test results, and disease diagnosis. A lung allocation score ranges between 0-100, and the higher the score, the higher your placement is on the waitlist for a new lung when it becomes available.

Recovery time varies from person to person but on average, lung transplant patients will stay in the hospital for 1-3 weeks after surgery. However, complications do arise, so you may need to stay in the hospital for a longer time. After discharge, you will have to make frequent visits to your hospital for the next three months. Following those three months, your doctor decides whether or not your visits should become less frequent. The average person takes 3-6 months to recover and return to a healthy and normal lifestyle.

Prior to surgery, you will be given general anesthesia so you fall into a deep sleep. Once you are asleep and attached to the necessary monitoring lines, an incision is made to either the left or the right side of your chest depending on which lung is being removed. If it’s a double-lung transplant, an incision is made across your entire chest, just below the breast. Your lung is removed and then replaced with the healthy donor lung. A surgeon connects blood vessels to and from the donor lung as well as the airways between the new lung and you. In a double-lung transplant, one lung is removed and replaced before the same is done with the next lung.

In a heart-lung transplant, you will be attached to a heart-lung bypass machine that does the work of your heart while in surgery. Both lungs are removed and replaced closely followed by the removal and replacement of the donor’s heart.

The purpose of your body’s immune system is to fight off any foreign bodies, such as bacteria or viruses that may bring you illness. Your new transplant lungs will be considered “foreign” by your body and as such your body’s immune system will produce anti-bodies in an attempt to destroy them. This process is known as rejection. To prevent rejection, your doctor will put you on medication that will help slow and control this process. These same drugs will likely weaken your immune system, leaving you more susceptible to infection. Rejection and infection are two of the major risks associated with transplantation. Other risks may result from long-term use of the post-surgery medications you will be taking. Problems that may arise are diabetes, kidney damage, and high cholesterol.

Once a potential donor has been found for you, a transplant coordinator will immediately notify you. This is why it’s important to keep your contact information up-to-date with the hospital. The coordinator will then tell you what to do once you get to the hospital and will ask that you not eat or drink anything before arriving. Once you are admitted to the hospital, you will undergo blood work and other tests before surgery. Unfortunately, a call does not always mean that a transplant will happen. The donor organ may be found unsuitable upon closer evaluation and you will be sent back home. Keep in mind there is always a possibility that this may happen.

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