Lung Transplant

A lung transplant is surgery done to remove a diseased lung and replace it with a healthy lung from another person. The surgery may be done for one lung or for both. Lung transplants can be done on people of almost all ages from newborns to adults up to age 75.

A lung transplant may be advised for someone who:

• Has serious lung problems that can’t be improved with any other treatment, and
• Has a life expectancy of 12 to 24 months without a transplant

A lung transplant may be needed for the following conditions:

• Severe cystic fibrosis (CF): This is an inherited disease that causes problems in the glands that make sweat and mucus. It is ongoing, gets worse over time, and is usually fatal.
• Bronchopulmonary dysplasia or chronic obstructive pulmonary disease (COPD): These are lung diseases that can interfere with normal breathing.
• Pulmonary hypertension: This is increased blood pressure in the arteries of the lungs.
• Heart disease: Heart disease or heart defects that affect the lungs may need a heart-lung transplant.
• Pulmonary fibrosis: This is scarring of the lungs.
• Other diseases: Other conditions that can cause severe lung damage include sarcoidosis, histiocytosis, and lymphangioleiomyomatosis. Also, certain hereditary conditions can affect the lungs.

Not all people with these conditions need a lung transplant. A lung transplant is not advised as a treatment for lung cancer. Your healthcare provider may have other reasons to advise a lung transplant.

Potential recipients of lung transplants at the INTEGRIS Nazih Zuhdi Transplant Institute must meet the following lung transplant criteria to join the lung transplant list. Criteria for a lung transplant include:

Criteria list adapted from JHLT 2006; 25:745-755; early referral highly desirable:

• Cystic Fibrosis
  • FEV1 <30% predicted or rapidly decreasing FEV1
  • Pulmonary hypertension
  • Increasing antibiotic resistance
  • Life-threating hemoptysis
• COPD
  • BODE index >5
  • PaCO2 >50% or PaO2 <60%
  • FEV1 <25% predicted
• Interstitial Lung Disease
  • FVC<80% predicted or DLCO <40% predicted
  • Dyspnea or functional limitations
  • O2 required with exertion
    
    

You will first be evaluated by a transplant team. The team may include:

• A transplant surgeon
• A healthcare provider specializing in the treatment of the lungs (transplant pulmonologist),
• One or more transplant nurses
• A social worker
• A psychiatrist or psychologist
• A dietitian
• A chaplain
• An anesthesiologist

The transplant evaluation process includes:

• Psychological and social evaluation: This includes assessing your stress, financial issues, and support by family and other loved ones. These issues can have a major affect the outcome of a transplant.
• Blood tests: Blood tests are needed to help find a good donor match. This helps improve the chances that the donor organ will not be rejected.
• Diagnostic tests: Tests may be done to check your lungs and your overall health. These tests may include X-rays, ultrasound, CT scans, pulmonary function tests, lung biopsy, and dental exams. Women may also get a Pap test, gynecology evaluation, and a mammogram.
• Stopping smoking: Lung transplant recipients who smoke must quit. They must be nicotine-free for several months before being put on the transplant list.
• Other preparations: Several immunizations will be given. These are to lessen the chance of infections that can affect the transplanted lung.

In some cases, a person shouldn’t have a lung transplant. Reasons for this can include:

• Current or recurring infection that can’t be treated
• Cancer that has spread to other parts of the body (metastatic cancer)
• Severe heart problems
• Health problems that make the person unable to tolerate surgery
• Serious health conditions other than lung disease that won’t get better after transplant
• Not being willing or able to stick to all treatment requirements for getting a lung transplant

The transplant team will consider all information from interviews, your medical history, physical exam, and diagnostic tests in deciding your eligibility for a lung transplant.

Once you have been accepted as a transplant candidate, you will be placed on a waiting list of the United Network for Organ Sharing (UNOS). Waiting times vary greatly. They depend on which organ(s) you need, your age, your blood type, and the reason for your transplant.

When a donor organ is available, you will be notified and told to come to the hospital right away so you can be prepared for the transplant.