Lung disease is characterized by the inability to breathe — that most basic of all human biological functions. People with lung disease are likely to experience shortness of breath, chronic cough and exhaustion. If the condition is severe and untreated, the patient eventually will die.
Lung transplantation for patients with severe diseases of the lung — such as emphysema, cystic fibrosis, pulmonary fibrosis, sarcoidosis and pulmonary hypertension — is considered only after all other treatments have failed. In some cases, congenital heart disease may cause advanced lung disease, requiring repair of these heart defects at the time of lung transplantation.
To be eligible for a lung transplant, you must meet the following requirements:
- You must be physiologically 60 years of age or less for bilateral lung transplantation and 65 years of age or less for single lung transplantation. This means that your physical condition must at least meet the typical condition of someone 60 years old or younger, or someone 65 years old or younger. Your chronological age is not a factor.
- You must have a poor prognosis, with an anticipated 18 to 24-month survival.
- You must have no other life-threatening systemic disease.
- You must have demonstrated absolute compliance with medications and medical recommendations, and have good rehabilitation potential.
- You must demonstrate emotional stability and must have a realistic understanding of the implications of organ transplantation.
- You must have a good social support system.
Transplant candidates undergo a battery of tests that may include routine blood work, electrocardiogram (ECG) and other radiological and diagnostic procedures.
If accepted as a lung transplant patient, you will join many other patients who are awaiting a transplant. You will be seen on a regular basis to monitor your progress.
As a result of your lung condition, you may have several associated problems that must be addressed. These include:
- Shortness of breath and increased oxygen need
- Decreased activity level
- Wasting of your muscle groups including respiratory muscles, postural or trunk muscles, and your arm and leg muscles
- Cardiovascular deconditioning
- Fear or anxiety due to breathlessness
Evaluation in a pulmonary rehabilitation program is essential if you are considering transplantation. It is important that you be in the best physical shape as possible at the time of your surgery. Lung transplantation will improve your shortness of breath and oxygen need. Therefore, you will be introduced to the importance of exercise and activity before your transplant. This will include training your respiratory muscles as well as a biking or walking program for general conditioning. You will need to continue this program even after your transplant occurs.
After being approved for transplantation, patients are immediately put on the organ donor waiting list. Your placement on the waiting list is determined by the severity of your condition and the likelihood that your transplant would be successful, known as your lung allocation score. Those with higher scores get higher priority when a compatible lung becomes available.
A new lung or lungs will come from a person who is an organ donor. This person has suffered an injury to the blood supply to the brain, which results in “brain death.”
The surgery takes from six to 10 hours, depending on medical conditions. After surgery, you will go to intensive care. From there, your are transferred to a cardiothoracic unit. The expected length of stay for an uncomplicated lung transplant is eight to 21 days.
If you are having a single lung transplant, the incision will be made on your side, either right or left, about six inches below your armpit. Your old lung will be removed through this opening and the new lung will be implanted. In the case of a double lung transplant, the incision will run across the lower part of your chest. The lung, whether single or double, is connected to the pulmonary artery, pulmonary veins and the main stem bronchus or airway. The incisions will be uncomfortable and will take several weeks to heal.
Once your surgery has been completed and the lung transplant is a technical success, the issue of successfully living with a transplant becomes quite involved. The two major issues are rejection and infection.
Rejection is the natural process of your body that recognizes your new lung as being foreign to the body and attempts to destroy it. This reaction originates within your immune system. This is similar to the way your body identifies a splinter in your finger as a foreign object. The redness and inflammation in the area of the splinter is an immune response. To prevent rejection, you must be treated with immunosuppressants, medications that interfere with the body’s normal immune response.
It is expected that you will have episodes of rejection in the first several months after transplant. The treatment requires that you receive doses of the anti-rejection medications intravenously. You will require frequent blood sampling to determine the levels of immunosuppressant drugs, as each individual is unique and requires an individualized approach. The goal is to find the lowest immunosuppressant dose that will prevent rejection and therefore minimize the risk of infection and side effects from the medications. Failure to take these medications will result in the rejection of your new lung.
Because your immune system is suppressed to prevent you from rejecting your new lung, you will be more prone to infection. Your temperature and white blood cell count will be monitored for signs of infection. Infections are generally treated with antibiotics and you will be asked to take certain medications on a regular basis to prevent certain types of infection. You may have to undergo intermittent short courses of intravenous antibiotics. The signs of infection are redness, swelling and tenderness at a surgical site. A new lung infection may begin with a mild fever, new cough and change in lung secretions.