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A lung transplant involves the removal of one or both diseased lungs and the surgical placement of a healthy donor lung in its place. This requires three connections: the airway, the pulmonary artery and the pulmonary veins. Usually, the other diseased lung is used to breathe for the patient during the surgery, although occasionally cardiopulmonary bypass (heart-lung machine) is used. The surgery usually lasts 5-10 hours. The new (transplanted) lung begins working immediately and gradually provides most of the lung function.
Individuals with idiopathic pulmonary fibrosis, sarcoidosis, emphysema due to genetic or nongenetic factors, primary pulmonary hypertension, bronchiectasis and cystic fibrosis have received lung transplants.
Each candidate is evaluated infividually to determine whether a transplant is the most appropriate treatment. Age is an important consideration, as most transplants are performed on people under 55 years of age. Other considerations include the health of other organs such as the kidney, liver and heart, as well as the use of certain medications such as corticosteroids.
Evaluation for a lung transplant involves several tests, as well as evaluation by various members of the transplant team. Typically, prospective patients are seen first by the team's Medical Director, who reviews the individuals medical records, x-rays and related materials and interviews and examines the individual.
If the individual decides to proceed, a three-part evaluation procedure is begun. This includes x-rays, blood tests, tests of heart and lung function and various cultures; meeting with doctors who specialize in Infectious Disease, Anesthesiology, Cardiology, and Psychiatry, as well as Social Work and Nutrition staff; and finally, a comprehensive assessment by the Pulmonary Rehabilitation Program. Individuals are tested to determine their strength and general level of fitness and are started on a supervised exercise program designed to increase their fitness prior to transplantation. Once this careful evaluation is completed, the Lung Transplant Team discusses the results and decides whether transplantation is the most appropriate choice of therapy.
The BWH team then presents its decision to representatives of the Massachusetts Center for Lung Transplantation. If both groups agree that a lung transplant is appropriate for the patient, he or she is accepted as a candidate and listed with the New England Organ Bank which obtains donor organs for transplantation throughout the region.
Donor and recipient are matched by blood type and by lung size.
The body's immune system has the job of recognizing and getting rid of foreign substances-typically bacteria, viruses, fungi, etc. After a transplant, it recognizes the transplanted lung as a foreign object and attempts to rid the body of it. This process is called rejection. Chances of rejection are highest in the first 3-4 months after the transplant.
Rejection is prevented by using a combination of medications designed to interfere with the immune system's recognition of the lung and prevent any attack by cells on the lung. Typically, patients are on two or three immunosuppressive (antirejection) medications in the first months after the transplant. Note that all organ transplant patients need to take antirejectin medications for the rest of their lives. As time goes by, these medications are gradually reduced. The effects of these medications will be discussed with you by the Lung Transplant Team.
How do you decide whether to do a single or double transplant?-Most lung transplants are single-lung transplants. Experience to date has shown that most patients get excellent functional results from a single-lung transplant. Double-lung transplants are reserved for patients with infectious lung disease, where both lungs are affected. In this case, both lungs are transplanted so as not to have an infected area present when immunosuppressive (antirejection) medications are started after the transplant.
You will see many of the same doctors who evalutated you as an outpatient, as well as the resident staff of the surgical service. You will be assigned a Primary Nurse in addition to being cared for by nursing staff from the Operating Room, Intensive Care Unit and the Thoracic Intermediate Care Unit. Your primary nurse will establish your care plan, teach you routines you will follow in the hospital and at home, and generally sees that you and your family have a chance to ask questions, discuss progress, and make plans for going home. Your care will be coordinated and supervised on a daily basis by the directors of the Lung Transplant Team.
Each case varies, so we cannot predict how long any patient will be in the hospital. Typically, patients should expect to be hospitalized for about one month after their surgery. This time varies and may be longer if complications occur.
Immediately after surgery, you will begin taking immunosuppressive medications to prevent rejection. Special precautions will be taken to prevent infection, including wearing a mask when you leave your room. Staff and visitors will wear gown, gloves and masks when visiting you in the first weeks after your surgery. We ask that family members and friends suffering from communicable illnesses, such as colds or flu, not visit you until they have recovered.
You will resume normal physical activity and eating soon after the surgery. An important part of the recovery period in the hospital is daily physical therapy and maintaining good nutrition. Much of your time will be spent on physcial therapy, testing, and rest periods.
For the first several days after your surgery, you will be in the Surgical Intensive Care Unit. Family members may visit you for shourt periods throughout the day. We ask that they first call the nursing staff to see that it is a suitable time to visit.
Once you are transferred to the Thoracic Intermediate Care Unit, you are allowed visitors during regular visiting hours (1:00-8:00 p.m.). Note that all visitors are required to wear protective gowns, gloves and masks.
Because a lung transplant can be emotionally difficult for both patients and family members, there is an extensive support system in place. Members of the Lung Transplant Team, including nursing staff and social workers, are prepared to provide any support that is required, or to refer you for psychiatric help if necessary.
For the first several months after you go home, you will come to the hospital once a week to be seen by one or more members of the Lung Transplant Team. In addition, you will be seen by the Pulmonary Rehabilitation Team, who will monitor your recovery and supervise your exercise program. Once you have regained your strength and your medications have been appropriately adjusted, you may gradually resume normal activities, including returning to work.
Most transplants are paid for by insurance. We usually need to obtain approval from the insurer prior to the transplant. Except in cases where transplantation is considered experimental treatment, there is usually no difficulty in obtaining payment. If problems arise, the transplant social worker can assist with any financial or insurance concerns.
The likelihood of a successful result is partly determined by the disease that made the trfansplant necessary. We suggest that you ask a member of the transplant team about your specific case. Note that we conduct an active clincial and basic science research program, which ensures that our patients benefit from the most recent advances in transplantation medicine.
Let your primary doctor know of your interest, and ask him or her to arrange a referral for a transplant evaluation. You can also call(617)732-7269 and ask to speak with the Transplant Coordinator or submit an appointment request form over the web. An appointment will be scheduled; you will be asked to bring relevant medical records and x-rays with you. After your evaluation, a letter will be sent to your primary doctor informing him or her of the results and requesting any further information that is needed.
After you are examined and your medical condition reviewed, you will have the opportunity to discuss transplantation and its implications with members of the Lung Transplant Team. It is often helpful for any interested relatives to attend at least one meeting with the transplant team. We feel strongly that you and your family should be as fully informed about your lung transplantation as possible.
We recognize that there are many questions about lung transplants that cannot be answered by the medical staff and are better handled by transplant recipients. So that you can ask these questions and to help deal with the stresses that medical illness and transplantation can cause, we have organized a Lung Transplant Support Group. This group meets every other Wednesday evening and is attended by patients who have had transplants at BWH and other hospitals, people awaiting a transplant, people considering transplantation, and relatives of all of the above. It is organized and run by the Lung Transplant Coordinator and the social worker on the team. All interested individuals are welcome to attend. Further information about the group and a schedule of meeting times can be obtained by calling the transplant coordinator at (617)732-7269.
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©2007, Division of Thoracic Surgery at Brigham and Women's Hospital. All rights reserved.
Division of Thoracic Surgery
Brigham and Women's Hospital
75 Francis Street
Boston, MA 02115
Phone: (617) 732-6824