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Lung Transplants

Lung transplants are given to people as a last resort treatment for irreversible lung failure. Lung failure happens when the lungs are damaged and unable to transfer oxygen and carbon dioxide to and away from cells. Some diseases that cause the lungs to fail and are treated with transplants are emphysema, including the form caused by the alpha-1-antitrypsin-deficiency, pulmonary fibrosis, cystic fibrosis, and pulmonary hypertension. Lung transplantation is not recommended as a treatment for lung cancer.

  • In 2005, approximately 3,500 people in the U.S. were waiting for a lung transplant, yet only 1,000 of them (25 percent) received a transplant. Unfortunately, with the improvement of surgical techniques and the expansion of reasons for transplants, the number of needed lung transplants has not kept pace with the number of available donors.
  • Making the decision about whether to get a lung transplant when it involves life and death may seem easy, but getting the transplant has risks like any other major operation. There may be surgical complications such as major bleeding, pneumonia and pulmonary edema and possibly painful recovery. In addition, patients may have the burden of taking medication that lower their immune system response and expose them to serious side effects, including cancer.
  • Transplant recipients also have a high risk of rejection and infection.  Since the transplanted lungs are considered foreign to the body, there is a risk that the body’s immune system will attack and reject the new transplant. Doctors prescribe immunosuppressive (anti-rejection) medication, which lowers immunity to prevent rejection, but also increases the risk of infection and other diseases. Rejection most often occurs the first three months after transplantation, but medication may need to be taken indefinitely.
  • A team of specially trained staff (pulmonologists, surgeons, immunologists, social workers, nurses and technicians) evaluates patients to establish whether he or she would be a good candidate for a lung transplant.  The person’s physical and psychological health and suitability for major surgery are taken into account.
  • When a patient is considered to be a good candidate, their name is put on a national waiting list for an organ transplant. Waiting time may extend several years.  Unfortunately, the majority of qualified candidates will not live longer than 1 or 2 years without a transplant.  In 2004, close to 533 people waiting for a lung transplant died.
  • Once there is a deceased lung donor, a ranked list of people is computer-generated. The transplant recipient is chosen based on certain requirements, including immune markers that match the donor, lung size, length of time on the waiting list and proximity to the donor. Each transplant center may have additional criteria also. Once a candidate is chosen, time is critical.  The lung must be transplanted into the patient receiving the organ with 4 to 6 hours.
  • Depending on the chosen recipients’ need, a single or double lung transplant may be performed. Double lung transplants involve an incision below the breasts and take about 6-12 hours of surgery. For single lung transplants, the incision is made on the side of the body where the lung is to be replaced; the operation takes about 4-8 hours. Once the lungs are replaced, the blood vessels and airway are attached.
  • In some cases where the heart has been weakened, both the heart and lungs will be replaced. Until 1989, combined heart-lung transplants were the most common form of lung transplantation.  Since then, single lung transplants has become the most common form.
  • After surgery the patient will make frequent trips to the medical center and have a prescribed home-based rehabilitation program including physical activity, breathing exercises, nutrition and taking medications especially immunosuppressive drugs. Walking is recommended to restore strength and prevent lung complications.  More strenuous activity can resume when one is comfortable.
  • Current survival rates are as high as 80 percent at 1 year following transplantation and 60 percent at 4 years.
  • Lungs can also be transplanted from living donors, adding to the supply of available organs. A living lung donor can be anyone who matches the recipient, related or not. At least two other people have to donate lobes to form an entire lung for one recipient; lobes of the lung are donated depending on which sections of the lungs need to be replaced. Living lung transplants are advantageous because recipients do not have to wait on a list and the transplant can be scheduled at a time convenient for both parties. In addition, the recipient can begin to take immunosuppressive medication earlier, which decreases the chances of rejection. Living lung transplants tend to be more successful also because there is a closer match between the donor and recipient. Unfortunately, as of now, the living donor program for lungs is in its infancy, so it will not be available for most people needing a transplant at this time.