Preparation for lung transplants
Becoming eligible for a lung transplant is a sometimes lengthy process of making sure that you are healthy enough to undergo this major surgery. You will begin by meeting with a transplant team, and they will conduct a series of evaluations, including:
- Blood tests to help find a suitable donor match.
- Diagnostic tests to check your overall health and the health of your lungs. Tests may include x-rays, ultrasound, pulmonary function tests, and biopsies, among others.
- Psychological evaluations to look at your stress, financial situation, and family or community support.
- Quitting smoking is required. Patients must be nicotine-free months before being added to the transplant list.
Once you’re eligible, you’ll go on the waiting list for a donor lung. Most lungs come from deceased donors, though in some cases, healthy, nonsmoking adults can donate a lung. Waiting times vary once you are on this list.
You will be notified when a donor organ becomes available and will be required to come to the hospital immediately. You may need to carry a pager or other device with you at all times to make sure you can be reached. Once a donor lung becomes available and matches with you for tissue compatibility, it generally must be transplanted within five to six hours.
As soon as you hear that lungs are available to you, stop eating and drinking. At the hospital, you will work with your care team to get ready for surgery.
A thoracic surgeon will perform your lung transplant. The surgery involves opening the chest to remove the diseased lung. You may be on a heart-lung machine during surgery, depending upon your condition and the type of lung transplant. This machine sends blood and oxygen through your body during your operation. All surgeries will include anesthesia.
Your surgeon will remove your diseased lungs and replace them with the donor lungs. They will attach the new lung’s blood vessels and airways, then close the incision. There will be one or more tubes put into your chest to remove air, fluid, and blood from the chest. This will also allow the new lungs to expand fully.
Single lung transplants can take four to eight hours. Double lung transplants can take up to 12 hours. In either case, you’ll spend a few weeks in the hospital. You will first be taken to a recovery room and then to the intensive care unit (ICU).
Recovery after a lung transplant can take several months. As you recover in the hospital, you will have a catheter until you can pass urine on your own, a breathing tube hooked up to a ventilator, and a tube in your nose and throat to remove the air you swallow. You will be given pain medicine to keep you comfortable. Slowly, you will begin to drink liquids, and later, solid foods.
Pulmonary rehabilitation can help you recover and return to daily living.
To help your body accept a donor lung, you will need lifelong antirejection drugs. These medicines can cause their own side effects and complications. However, they are vital to maintaining your transplant.
After recovery, in addition to taking lifelong antirejection medicines and managing their side effects, you’ll need to consider making these changes in your everyday life:
- Watch for signs of rejection.
- Don’t smoke.
- Follow a lifelong health care follow-up plan, including chest x-rays, pulmonary function tests, and bronchoscopy.
- Prevent illnesses and infections.
- Plan any attempt to become pregnant carefully.
Once you are at home, follow instructions from your care team about keeping your incision clean and dry and generally taking care of yourself.
Transplant recipients often need support to work through the emotional issues of transplantation. Talk to your doctor about connecting with experts who can help.
Taking care of your new lungs will be a life-long commitment. You will need to manage your medications and therapies to keep your body from going into rejection mode. Living a healthy lifestyle is also vital to sustaining your new lung. You will work with your care team to develop an exercise plan that works for you.
A lung transplant should have a drastically positive effect on your quality of life. Rejection and infection are real risks, especially within the first year after the transplant, and recovery is a long process.
Lung transplants have sustained some patients’ lives over 10 years. Generally, about half of the people are alive five years post-transplant.
Getting a lung transplant can be an emotionally difficult time, and your care team will be able to help you with resources and coping strategies. Support groups, therapy, rehabilitation services, and assistance with goal setting are all critical for your emotional recovery.
Who is not a candidate for a lung transplant?
Lung transplants are not right for everyone. Even if your doctor recommends a lung transplant, you may not be a candidate for a lung transplant if:
- You have an active infection
- You have recently had cancer
- You are unwilling to make lifestyle changes to keep your new lung(s) healthy
- You have a serious condition, such as heart disease
- You do not have a supportive network
Your care team will work with you to find an appropriate treatment for your lung condition, whether that is a lung transplant or a different path.
The information contained in this article is meant for educational purposes only and should not replace advice from your healthcare provider.