Lung Transplant - General Information
There are lung transplants centers
throughout the world; therefore, the information below is generalized as
all centers and hospitals have their own criteria and set of guidelines.
This is not intended to be used as medical advice, only as simple general
background information on lung transplantation.
Patients are usually referred for lung transplant by
their primary care physician or pulmonologist.
Once referred to a center or hospital, an initial
consultation is conducted, reviewing the patient's previous health
records and tests, such as pulmonary function tests, X-rays, etc.
Time is also devoted to the pros and cons of lung
transplantation. For each individual patient, both the patient and their
physicians need to weigh the risks and potential benefits of having a
transplant versus the risks of not having a transplant.
Financial responsibility is usually determined at this
time, as well.
If a patient is considered a potential candidate, they
must undergo further assessment and evaluation, which includes a battery
of new tests based on each individual patient. These extensive medical
tests, including a psychological workup, can take several weeks. During
this time, further testing may be ordered or, in some cases, alternative
treatment, therapy or procedure recommended.
A decision may also be made to defer on listing a
patient if they are too early or some aspect of their situation is in
question. Or a patient may be rejected or accepted in this pre-transplant
Accepted for Transplantation
After patients are accepted for transplantation, they
are listed with the United Network for Organ Sharing (UNOS), the
national computerized listing organization that matches transplant
recipients with available organs.
When a patient is added to the UNOS transplant waiting
list, their medical information is entered into the UNOS computerized
database. This system adds the patient's name and medical history into a
"pool" of patient names. Once an organ donor becomes available, the
computer then generates a list of patients who match the donor organ.
Matches are based on such criteria as:
- locality (where the patient is listed)
- time spent on the waiting list: Lungs are
distributed on a "first come first serve basis." There is no
prioritization for lung transplant candidates except for patients
with idiopathic pulmonary fibrosis (IPF). These patients are
"given" three months on the transplant list. This is because of
the poor prognosis associated with this condition.
- blood type
The Waiting Period
Donated organs always are distributed locally first.
If a suitable match for the organ does not exist in the local area, the
organ is offered regionally, and then it is offered nationally.
A patient who is accepted as a lung transplant
candidate is given a pager to ensure that they can be contacted as soon
as a suitable donor lung is available.
The national average wait is approximately 18 months.
During this time, the patient participates in a pulmonary rehabilitation
program and frequently sees the transplant pulmonologist. It is
imperative that the patient maintains the best health possible during
Fewer lung transplants are performed than other solid
organ transplants. It is estimated that for every four to five donors
who have hearts suitable for donation, only one of these donors will
have lungs that will be suitable. Lungs tend to be somewhat fragile
compared with other organs. Frequently, the next organ to deteriorate
after brain death is the lungs.
Donor Lung Evaluation
There are many potential pitfalls when procuring a new
lung. Donor lungs go through a series of extensive testing. It is not
uncommon that a pair of lungs that by all guidelines appear healthy,
turns out to have a problem that is only evident at the time of surgical
It is not uncommon for any potential lung transplant
recipient to have one or more "false alarms," where the patient is
admitted for surgery only to find out that the donated organs are
unsuitable for transplantation.
Following surgery, the patient is hospitalized an
average of about two weeks. After surgery, the patient is placed in ICU.
Eventually, the patient is transferred to a unit where staff members are
experienced in the care of transplant recipients.
During the recovery period, the patient is told what to expect during
the recuperation period and what to do after being discharged, including
information on the regime of drugs needed to be taken daily to prevent
rejection and infections.
Source: Compiled by COPD-International Community
Members from sources deemed reliable.