Lung Transplantation at RWJBarnabas Health

Dr. Joshua Lee, director, Lung Transplant, Advanced Lung Disease and Transplant Program at Newark Beth Israel Medical Center, discusses his relationship with his patients, the life-changing experience of advanced lung disease and the patient journey to lung transplant.

A lung transplant is a type of surgery performed to remove a person’s diseased or failing lung and replace 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 correctly. Some of the more common causes include:

Lung transplantation is an option for patients with severe lung disease who experience ongoing symptoms despite medical management. These symptoms include shortness of breath, fatigue, or near fainting when performing normal daily activities or at rest.

Lung damage can often be treated with medication or with special breathing devices. When such measures are no longer effective or the disease progresses to a life-threatening stage, doctors may suggest a lung transplant. In some cases, people with serious heart and lung conditions may need a combined heart and lung transplant.

Criteria for a Lung Transplant

Jesus Gomez-Abraham, MD, associate surgical director lung transplantation at RWJBarnabas Health, RWJBarnabas Health Medical Group discusses what type of patients are candidates for a lung transplant, the transplant process and the exciting outcomes for transplant patients today.

A successful lung transplant is a life-changing event, however, not everyone may qualify for a lung transplant. Some factors that are considerations for lung transplant candidacy are:

  • A co-existing medical condition that could shorten a person’s life.
  • Active infection.
  • Recent personal history of cancer.
  • Unwillingness to make lifestyle changes necessary to keep a donor lung healthy (for example, drinking or smoking).

Based on all of the above, doctors will identify whether a person is a candidate for a lung transplant.

Lung transplant candidates are generally those experiencing end-stage lung disease whose symptoms progress despite optimal medical management. Ideal candidates must meet certain criteria. There are also absolute and relative contraindications to lung transplants.

The lung transplant waiting list is run by the United Network for Organ Sharing (UNOS), a non-profit scientific organization. UNOS oversees all transplant programs in the country — using a national computer system and strict standards to ensure ethical and fair distribution of lungs.

Medical factors that influence lung matching include:

  • Blood group compatibility
  • Geography
  • Organ size
  • Predicted survival benefit
  • Medical urgency
  • Distances from the donor hospital
  • Pediatric status

There are certain instructions that patients are asked to follow while on the waiting list. Your medical team will closely monitor your condition. Your doctors may recommend a pulmonary rehabilitation program.

Lung Transplant Success Rates Improve with Adherence to Post-Surgery Care

A key element of a successful lung transplant is the prompt identification and management of any complications that may arise. The most common complications are rejection, infection and side effects of immunotherapy.

Life after a lung transplant consists of doctor visits, immunotherapy, rehabilitation and lifestyle modifications. Patients who adhere to their doctor’s recovery plan and instructions increase their chances of lung transplant success.

Learn more about lung transplant survival rate and life expectancy.

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 a transplant.

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

Diagnostic tests and procedures may include:

Donor organs become vulnerable to the interruption of blood flow that occurs once they are removed from the donor. To ensure the highest success rates, lungs are first offered to transplant centers nearby, then to centers within certain distances of the donor hospital.

  • When you are 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 will 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 are ready to have surgery. If it is decided that you are not, you may not be able to have the transplant.

A lung transplant 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:

  • Prior to starting the procedure, you will receive a local anesthetic.
  • Your doctor will administer general anesthesia, which will make you feel sleepy.
  • Once you are sedated, your doctor will insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
  • 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.
  • In some cases, you may be connected to a heart-lung machine. This machine replaces 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 of sutures or surgical staples.

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

Lung Transplant Recovery

Here’s what you can expect when recovering from a lung transplant:

  • The breathing tube is removed when you wake up from anesthesia and the transplanted organ has begun to function appropriately.
  • Diet is started the day after surgery with liquids, and quickly advanced to solids as tolerated.
  • On the first or second day after surgery, you will be asked to get up and walk a bit.
  • 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 health care 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 additional instructions to follow during your recovery.

Meet Our Team

RWJBarnabas Health’s Advanced Lung Disease and Transplant Program at Newark Beth Israel Medical Center is the only lung transplant program of its kind in the state of New Jersey.

Our program provides comprehensive treatment and the management of chronic and complex lung disease, as well as increased access to transplant services (single or double lung transplant).

Instrumental to our program’s success is our passionate, experienced and integrated multidisciplinary team comprised of specialists skilled in all aspects of health care. To learn more about our team members, click the button below to visit our Advanced Lung Disease and Transplant Team page.

Advanced Lung Disease and Transplant Team

Frequently Asked Questions About Lung Transplants