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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.

Pre-Transplant/Consultation

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. 

Extensive Testing/Evaluation

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 stage.

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
  • size

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 this time.

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 removal.

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.

Recovery

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.

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