Lung Transplant

What is a lung transplant? 

A lung transplant is a major surgical procedure administered to replace one or both lungs after they have failed or are diseased.

A lung transplant is often the last treatment option after medication cannot correct the condition. Your surgeon will replace the failed or diseased lung with a healthy one from a deceased donor.

A living donor can also donate a section of their lung but this is very rare. It may be necessary to conduct a double lung and heart transplant.

The procedure improves the quality of life and health of a patient despite the many complications involved, including the risk of bleeding, infection, or rejection of the donor lung(s). 

Who needs a lung transplant?

A lung transplant is recommended:

• If you have advanced lung diseases where other methods of treatment have failed

• In case your life expectancy is 1-2 years in the absence of a transplant

The following conditions might also necessitate a lung transplant:

• Chronic obstructive pulmonary disease (COPD) – COPD is a chronic lung disease that affects normal breathing and is caused by smoking
• Severe cystic fibrosis (CF) – Cystic fibrosis is an inherited condition that interferes with mucus and sweat production. This is a fatal condition that exacerbates over time
• Heart defects – If you have heart diseases, this can interfere with your lungs, causing a heart-lung transplant
• Pulmonary hypertension – This refers to high blood pressure in the pulmonary arteries that transport blood from your heart to the lungs

The heart transplant team treats each case individually. However, you may be ineligible for a lung transplant under the following conditions:

• In case of a serious disease like liver, heart, or kidney disease

• In case you have an inactive infection

• If you cannot or are not willing to make lifestyle changes, such as smoking or alcohol intake to maintain the donor’s lung health

• If you have metastatic cancer that is, cancer that spreads to other parts of your body

Your risk for a heart transplant differs based on your general health alongside other factors.

Consult with your healthcare provider to identify the risk to which you may be highly predisposed.

Types of lung transplant procedures 

A lung transplant can be categorized into one of three kinds:

Single lung transplant

This procedure is usually done to remove one diseased or damaged lung. The diseased lung is replaced with a healthy one from a donor. 

A single lung transplant is mostly appropriate in treating pulmonary fibrosis.

If you have cystic fibrosis, then a single lung transplant may not be suitable for you. This is because the remaining lung could get infected and pass such an infection to the donated lung.

Double lung transplant

This procedure involves removing both of your lungs and replacing them with two healthy lungs from a donor.

A double lung transplant is often the main treatment for COPD or cystic fibrosis.

Heart-lung transplant

In a heart-lung transplant, both your lungs and the heart are removed and replaced with healthy lungs and heart from a donor.

A heart-lung transplant is often the treatment of choice for individuals diagnosed with severe pulmonary hypertension.

Preparing for a lung transplant

Before a lung transplant, your healthcare provider will take you through a detailed pre-transplant scaring. Such screening aims to ascertain that the lung transplant is the most appropriate treatment for you.

A transplant coordinator gathers useful information regarding your health. You will undergo the following as part of your transplant evaluation:

Social and psychological assessment

A lung transplant affects your social and psychological well-being.

It is important to evaluate your financial situation, stress, and the support you are getting from your family and loved ones. There is a need to assess these issues because they will impact the outcome of a lung transplant.

Diagnostic tests

These are the tests done by your healthcare provider to assess the condition of your lungs and your general health.

Examples of diagnostic tests that you may undergo include CT scans, X-rays, lung biopsy, pulmonary function tests, ultrasound, and dental exams.

Smoking cessation

If you are a smoker, you must stop smoking before the transplant team places you on the transplant list. This may take several months of not smoking.

Your healthcare provider will guide you on the steps that you need to follow to become nicotine-free.

Blood work

You will need to take various blood tests to help the transplant team find a matching donor for your lung(s). Blood tests minimize the risk of your body rejecting the donor organ.

Immunization

You will be given several immunizations to reduce the risk of infection as this can impact the transplanted lung.

The transplant team considers your past medical history, results from the diagnostic exams, information from interviews, and physical examination in deciding whether you qualify for a lung transplant.

After the transplant team has established that you are eligible for a lung transplant, they will place you on a waiting list.

Waiting times differ based on:

• Your blood type

• Age

• The kind of organ(s) that you require

• Reason for the transplant

Once a donor organ becomes available from a deceased donor, the hospital will inform you promptly.

You will be required to come to the healthcare facility immediately so that the transplant team start preparing you for the lung transplant.

In case a living donor becomes available, the transplant team will plan for a scheduled transplant. The potential donor(s) should be of sound health.

Your blood type and that of the donor(s) must be compatible to reduce the risk of organ rejection.

The donor will also need to take a psychological evaluation to determine that he/she is okay with the decision.

As you wait for a lung transplant, your healthcare provider will walk you through a healthcare plan that entails:

Medications

If your healthcare provider has prescribed any medication, you are advised to continue taking it as directed.

If you get another prescription from a different healthcare provider, let your primary healthcare provider know about it.

In case you are taking multivitamin supplements or over-the-counter medication, notify your healthcare provider.

Anti-inflammatory drugs, some health supplements, and aspirin may predispose you to bleeding. You may be asked to stop taking such drugs.

Lifestyle modification

Your healthcare provider will ask you to stop taking alcohol. If you are a smoker, you must stop smoking several months before a lung transplant.

In case you are obese or overweight, you may need to lose weight.

Physical exercise

The transplant team needs to ensure that your lungs are as healthy as possible before the procedure.

Your physical therapist will walk you through a suitable exercise program to improve your physical condition.

You may need to work with a respiratory therapist to develop a suitable breathing exercise program.

Scheduled appointments

Your healthcare provider will organize several appointments with the lung transplant team to assess your overall health.

Preparation

You will need to be always prepared so that you can rush to the hospital as soon as a donor lung becomes available.

Make sure you have an emergency bag ready with all the personal items like toiletries, reading materials, and clothing you will need at the hospital.

It is important that you have a means of transport ready to get you to the hospital immediately.

Talk to your healthcare provider to find out if they offer transport services for their patients during surgery.

During the procedure 

A lung transplant is conducted under general anesthesia. An anesthetist will deliver the anesthesia through an IV line into a vein on the hand or arm.

The anesthesia puts you to sleep during the procedure. You do not also feel pain during a lung transplant.

You are also hooked on an electrocardiogram (EKG) to monitor your blood pressure and heart rate.

The transplant team will help position you on the operating table, based on the kind of lung transplant that you are having.

For a single lung transplant, you can either lie on your back or your side.

In case of a heart-lung transplant or a double lung transplant, it is advisable to lie on your back.

After you fall asleep, you will be hooked to a mechanical ventilator. The mechanical ventilator takes over your breathing function.

A urinary catheter is connected to your bladder to expel urine from your body during the lung transplant.

An extracorporeal membrane oxygenation (ECMO) machine may be necessary for a lung transplant. This device assists your transplant surgeon in bypassing the flow of blood to the lungs and heart.

An ECMO device takes over the role of pumping blood across your body. The device further eliminates carbon dioxide from your blood and replaces it with oxygen. This maintains healthy tissues.

If you have a hairy chest, the transplant surgeon can decide to have the incision area shaven.

The skin will also be sanitized using an antiseptic.

If you are undergoing a single lung transplant, your transplant surgeon makes a chest incision on the diseased or damaged lung using a scalpel.

Alternatively, the transplant surgeon can make an incision via the breastbone as usually happens with a heart surgery.

In case of a double lung transplant, the transplant surgeon makes a horizontal cut across the chest below the breast tissue.

The transplant surgeon removes the damaged or diseased lung and connects the donor lung in place.

The transplant surgeon uses small surgical threads and needles to connect airways and blood vessels.

The transplanted lung needs blood vessels to receive blood, a process known as vascularization. This is important for ensuring the tissue remains alive.

The transplant surgeon ensures air passage via your airways into the transplanted lung. He or she will also ensure the transplanted lung is receiving blood.

The surgeon replaces the small silicone tubes in the diseased section of the lung. The purpose of doing this is to drain fluid, air, and blood from the chest.

The drainage tubes are also important in assisting with the expansion of the new lungs.

The next step is for the surgical team to disconnect you from machines used during surgery. However, the catheter and mechanical ventilator will remain in place.

Finally, the transplant surgeon will close the incision using sutures or stitches and place bandages on the affected area as a cover. 

After a lung transplant

After a lung transplant, you will stay in the transplant intensive care unit (ICU) for a few days.

The transplant team will closely monitor your progress, including your breathing, heart rate, and other vitals.

While in the ICU, you will continue breathing via a ventilator until your lungs are strong enough to breathe on their own. This could take hours or a few days depending on an individual patient.

The catheter stays in place until you can pass urine on your own.

Your transplant surgeon will prescribe anti-rejection drugs and pain medication immediately.

Rejection comes about after your immune system detects the new lung(s) in your body, which is perceived as a threat.

The role of the anti-rejection medication is to suppress the natural responses of your immune system so that the new lung(s) is not rejected.

Once the transplant team has ascertained you are no longer in danger and are stronger, you will be transferred to a patient room where you continue with your recovery for a few more weeks.

While in the patient room, the transplant team will observe you closely for signs of lung rejection.

The transplant team will take blood samples a few times each day. The purpose of these tests is to assess the health of your liver, new lung(s) heart, kidneys, and blood system.

As you recover, your respiratory therapists and physical therapists will work with you during your stay at the hospital as part of your rehabilitation exercise.

You will be encouraged to move be on the move regularly. This prevents the collapse of your smaller airways in the new lungs. It also avoids blood clots.

Your transplant nurse will maintain a nil-by-mouth status for days or weeks after a lung transplant until they have ascertained that the swallowing function is working properly.

A “Nil by Mouth” further avoids aspiration of drink or foods into the new lungs which could be fatal.

Tubes and catheters are removed, and you will be slowly reintroduced to solid foods.

The transplant team will work with you and your significant family members to develop a recovery plan that works for you once you are discharged from the healthcare facility.

Some guidelines from the surgical team include:

• Keeping the incision dry and clean

• You will be guided on how to bathe until you have fully healed

• Your surgeon with organize a follow-up appointment when the staples and sutures will be removed

• Avoid engaging in any physical activity, including driving until your doctor has given you the green light

During your follow-up visits after the lung transplant, you will undergo the following tests:

• Chest X-ray

• Blood test

• Lung biopsy

• Assessment of your main lung airway

• Pulmonary function tests

The rehabilitation program can take several months.

If you experience any of the following while recovering at home, call your doctor immediately:

• In case the incision is leaking blood or fluid

• Trouble breathing

• If the incision is swollen or has a redness to it

• Increasing pain around the site of the incision

Benefits of a lung transplant

A Lung transplant can be a lifesaving procedure. It also improves overall health and quality of life. The main benefits of a lung transplant are:

Increased survival rate

A lung transplant is associated with an increased lifespan. For at least 55 percent of lung patients, a lung transplant increases their survival rate by about 5 years.

Some patients live for up to 20 years after a lung transplant.

Enhanced sex life and fertility

A lung transplant improves your sex life and increases the chances of getting pregnant in women. The procedure is associated with increased fertility in women.

Talk to your transplant surgeon about the risks of trying to get pregnant following a lung transplant.

Increased energy

People who have successfully gone through a lung transplant report experiencing a rejuvenation in their energy levels.

They can once more deal with everyday activities, including work.

Risks/Complications

Since a lung transplant is a major surgery, it comes with certain risks. Talk to your transplant surgeon beforehand to know the risks or complications that may accompany this procedure.

Some risks associated with a lung transplant are:

Transplant rejection

After you have had a lung transplant, your immune system interprets the new lung as a foreign invader and will attack it in the same way it would attack invasion by viruses or bacteria.

Immunosuppressive medication prevents transplant rejection. You have to take this medication throughout your life.

Infection

Since you are on immunosuppressants to avert your immune system from rejecting the new lung, this affects the ability of your immune system to fight infection.

This puts you at a higher risk of respiratory, blood, skin, and fungal infections.

Other risks of a lung transplant include:

• Bleeding

• Airways blockage

• Fluid accumulation in the lungs (severe pulmonary edema)

• Blood vessels in the new lung(s) could get blocked

• Blood clots

Cost of a lung transplant in India

The cost of a lung transplant in India averages from Rs.12,31,841 to Rs. 27,43,075. This cost varies based on the type of hospital, city, surgeon’s fee, and other factors.

The table below gives the average cost of a lung transplant across selected cities in India:

References

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