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What should I consider when
choosing a transplant center?
If your doctor recommends a lung transplant, you may be referred to
a transplant center. You're also free to select a transplant center
on your own or choose a center from your insurance company's list of
preferred providers.
When you're considering transplant centers, ask about the number and
type of transplants the center performs each year, as well as its
organ and recipient survival rates. You can compare transplant
center statistics through a database maintained by the Scientific
Registry of Transplant Recipients.
Also consider additional services provided by the transplant center.
Many transplant centers coordinate support groups, assist with
travel arrangements, help secure local housing for the recovery
period and offer referrals to other helpful resources.
Do I need to be accepted by the transplant center?
Yes. When you select a transplant center, you'll need an evaluation
to determine whether you meet the center's eligibility requirements
for a lung transplant. The team at the transplant center will assess
whether you:
* Are healthy enough to have the surgery and tolerate lifelong
post-transplant medications
* Have any medical conditions that would hinder transplant success
* Are willing and able to take medications as directed
* Are committed to quitting smoking, if you smoke
* Have family and friends to support you during this stressful time
Will I be placed on a waiting list?
If the team at the transplant center determines that you're a good
candidate for a lung transplant, you'll be placed on a nationwide
waiting list. According to the Organ Procurement and Transplantation
Network, about 3,500 people are waiting to receive a lung transplant
on any given day — but there are only enough donor organs to provide
about 1,000 lung transplants a year.
When a donor organ becomes available, the donor-recipient matching
system administered by the United Network for Organ Sharing (UNOS)
finds an appropriate match based on specific criteria, including:
* Blood type
* Geographic distance between donor organ and transplant recipient
* Lung allocation score
Your lung allocation score is determined by the type and severity of
lung disease and the likelihood of a transplant being successful —
not the amount of time spent on the waiting list. The only exception
is for children younger than age 12. Pediatric candidates receive
donor lungs based on the amount of time they've been on the waiting
list, blood type and distance to the donor hospital.
What about a living-donor lung transplant?
Living-donor lung transplants are rare, but possible — usually in
children. Typically one healthy adult donates a lobe, or segment,
from a left lung, and another donates a lobe from the right lung.
The lobes don't regenerate, and the procedure carries serious risks.
However, the ability to schedule the procedure ahead of time allows
the recipient to begin taking immune-suppressing medication earlier,
which reduces the risk of organ rejection.
What can I do to prepare for the lung transplant?
When you're waiting for a donated lung to become available, it's
important to keep your mind and body healthy.
* Take your medications as prescribed.
* Follow your diet and exercise guidelines.
* Keep all appointments with your health care team.
* Stay involved in healthy activities, including relaxing and
spending time with family and friends.
* Keep a positive outlook.
* Consider joining a support group.
A donated lung only remains viable for four to six hours after it's
removed from the donor, so be prepared to act quickly. Make sure the
transplant team knows how to reach you at all times. Keep your
packed hospital bag handy — including an extra 24-hour supply of
your medications — and arrange transportation to the transplant
center in advance. You'll most likely be expected to arrive at the
hospital within about two to three hours.
Before surgery, the surgeon will also do a final assessment of the
donor lung to ensure it's healthy and a good match. If there are
problems with the donor lung, the transplant may be canceled.
What happens during the transplant?
A lung transplant may take from four to 12 hours, depending on the
specific procedure.
In a single-lung transplant, the surgeon makes an incision on the
side of your chest and removes the diseased lung. The main blood
vessels to and from the new lung and the main airway of the new lung
are sewn to your main blood vessels and airway. Sometimes a
heart-lung machine is used to regulate blood flow and oxygen supply
during the procedure.
The incision for a double-lung transplant is made across the middle
of the chest. The process is similar to that of the single-lung
transplant, but the surgeon will do the entire procedure on one lung
before repeating it on the other.
If you're receiving a heart-lung transplant, you'll be hooked up to
a heart-lung machine. The diseased organs are removed, except for a
small portion of the heart to which the new heart will be sewn. The
new organs are transplanted as a whole system — the donor heart and
lungs aren't separated from each other. The airways of the new lungs
are attached to your main airway, and the main blood vessel (aorta)
of the new heart is attached to your aorta.
What can I expect after the transplant?
After the surgery you'll have a ventilator to help you breathe and
tubes in your chest to drain fluids from around your lungs and
heart. Expect soreness or pain around the incision site while you're
healing. Recovery often involves a one- to two-week hospital stay
and about three months of frequent monitoring by the lung transplant
team. During this time, you'll need to stay fairly close to the
transplant center.
Even with the best possible match between you and the donor, your
immune system will try to reject the new lung. Your drug regimen
will include medications to suppress your immune system. You'll
likely take these or other drugs for the rest of your life.
Some of these medications may cause noticeable side effects. Your
face may become round and full. You may gain weight, develop acne or
facial hair, or experience stomach problems. These effects may
decrease as time goes on.
Because medications to suppress your immune system make your body
more vulnerable to infection, your doctor may also prescribe
antibacterial, antiviral and antifungal medications. Some immune
system medications can also increase the risk of developing or
aggravating conditions such as high blood pressure, high cholesterol
and cancer.
Your post-transplant treatment will be a delicate balancing act
between preventing rejection and managing unwanted side effects.
Your doctor will monitor your treatment closely and adjust it as
needed. You'll also need to follow a diet and exercise program
designed to keep your new lung healthy. Smoking isn't allowed, and
use of alcohol is strictly limited.
What are typical survival rates?
A lung transplant can substantially improve your quality of life.
The first year after the transplant — when surgical complications,
rejection and infection pose the greatest threats — is the most
critical period.
The survival rate for single-lung transplants is more than 82
percent at one year, nearly 60 percent at three years, and more than
43 percent at five years, according to the Organ Procurement and
Transplantation Network. The survival rate for double-lung
transplants is similar — nearly 82 percent at one year, nearly 64
percent at three years, and more than 48 percent at five years.
What if my new lung fails?
Organ rejection is possible, and sometimes the underlying cause of
lung disease damages the new lung.
If your new lung fails, subsequent treatment options are limited.
You may choose to discontinue treatment. This important decision
depends on your current health and your expectations for maintaining
a certain quality of life. Discuss the choices with your doctor,
transplant team and family to determine what's best for you.
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