Lung Transplantation

A lung transplant is a type of open surgery performed to remove a person’s diseased or failing lung and replacing it with a healthy lung from a deceased donor. Depending on your medical condition, a lung transplant may involve replacing one or both lungs.

Unhealthy or damaged lungs can make it difficult for your body to get the oxygen it needs to survive. A variety of diseases and conditions can damage your lungs and hinder their ability to function effectively. Some of the more common causes include: chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pulmonary hypertension, and cystic fibrosis.

Lung damage can often be treated with medication or with special breathing devices. But when these measures no longer help or your lung function becomes life-threatening, your doctor might suggest a single-lung transplant or a double-lung transplant. In some cases, people with serious heart and lung conditions may need a combined heart-lung transplant.

Although a great solution for many, a lung transplant isn’t the right treatment for everyone. There are many factors that may disqualify someone, including: advanced age; a separate medical condition that could shorten your life; active infection(s), recent personal medical history of cancer; and the unwillingness to make lifestyle changes necessary to keep your donor lung healthy (e.g. not drinking or smoking). Based on all of the above, you and your doctor will identify the best treatment option for you.

How to prepare for lung transplant procedure

Preparations for a lung transplant often begin long before the surgery. You may begin preparing for a lung transplant weeks, months or years before you receive a donor lung, depending upon the waiting time for transplant.

Taking the first steps

  • If your doctor recommends that you consider a lung transplant, you'll likely be referred to a lung transplant center for an evaluation.
  • During an evaluation, your doctors will order several tests, including:

Diagnostic tests and procedures

Waiting for a donor organ: If the transplant team determines you're a candidate, then the transplant center will register you on a waiting list. While on this list:

  • Your medical team will closely monitor your condition.
  • Your doctors may recommend a pulmonary rehabilitation program.

What to expect before lung transplant procedure

A lung transplant usually needs to occur within four hours of organ removal for the donor organ to remain viable. As a result, lungs are offered first to a transplant center close by, then to centers within certain distances of the donor hospital.

  • When you're notified that a potential organ is available, you and your transplant team have a limited amount of time to consider whether to accept the donation. You'll be expected to travel to the transplant hospital immediately.
  • Once you arrive at the hospital, your doctors and transplant team will conduct a final evaluation to determine if the donor lung is suitable for you and if you're ready to have surgery. If it is decided that you are not, you may not be able to have the transplant.

What to expect during lung transplant procedure

Lung transplantation usually takes 4 to 6 hours, but the preparation and recovery may add several hours. The procedure is performed in the operating room (OR). Check with your doctor about the details of your procedure. In general:

  • You will change into a hospital gown.
  • Prior to starting the procedure, you will receive a local anesthetic. Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
  • Your doctor will administer general anesthesia (will make you feel sleepy).
  • The procedure begins when your doctor exposes your lungs by dividing the breastbone (sternum) in half. Your doctor then spreads both halves to gain access to your lungs (open-heart surgery).
  • In some cases, you may be connected to a heart-lung machine. This machine takes over for the heart by replacing the heart’s pumping action and the lungs by adding oxygen to the blood.
  • Your doctor will then proceed to remove the diseased lung and replace it with the donor’s lung. Your doctor will check to make sure everything is working properly.
  • Once the procedure is complete, the sternum will be sewn together with the use or sutures or surgical staples.

What to expect after lung transplant procedure

After the surgery, you will be taken to the intensive care unit (ICU) for further observation for several days. Lung transplantation typically requires a hospital stay of 7 to 14 days, or even longer. Other recommendations include:

General guidelines

  • The breathing tube is removed when you wake up from anesthesia.
  • Diet is started the day after surgery with liquids, and quickly advanced to solids as tolerated
  • Ambulation is started on the first or second day of surgery
  • Urine catheters and drainage tubes (chest tubes) are removed after 24 to 48 hours
  • Blood samples will be taken often to monitor your new lung, as well as other body functions
  • Your healthcare team will closely watch your anti-rejection (immunosuppression) medicines to make sure you are getting the right dose and the best combination of medicines.
  • Nurses, respiratory therapists, and physical therapists will work with you as you begin physical therapy and breathing exercises.
  • Your doctor will give you instructions to follow during your recovery

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