Lung transplant: Here are your questions answered.

In India, the success rate of lung transplants is around 85%. This could be the only life-saving option for terminal-stage lung diseases. Read more to learn about the procedure, eligibility criteria, and risks of a lung transplant.

What is a lung transplant?

An organ transplant is a surgery where an organ from one person (the donor) is given to another (the recipient) to replace their damaged organ.

A lung transplant is a surgical procedure in which one or both diseased lungs of a patient are replaced by the lung(s) of a donor.

What are the types of lung transplant procedures?

Lung transplant procedures can be:

Single lung transplant (transplantation of one lung)
Bilateral lung transplant (transplantation of both lungs)
Heart-lung transplant (transplant of both the heart and lung)

A patient is recommended for a single or double lung transplant depending on the availability of donor lungs, the number of patients waiting to receive a transplant, and the condition of the patient.

Why are lungs so important?

Lungs, the main organs of our respiratory system, are a pair of air-filled sacs located on either side of the chest and enclosed within the rib cage. The lungs exchange gases (oxygen and carbon dioxide) between our blood and the air. Oxygen in the air that we inhale reaches the smallest units of the lung called the alveoli, where it diffuses into the tiny blood vessels called capillaries. Simultaneously, the carbon dioxide in the blood is released into the air in the alveoli and exhaled out.

The functioning of the lungs can be affected by conditions such as asthma, pneumonia, chronic obstructive pulmonary disease (COPD), interstitial lung diseases, and lung cancer.

Who needs a lung transplant?

A lung transplant is recommended for patients suffering from end-stage lung disease when other methods of treatment are unsuccessful. These conditions include:

Chronic obstructive pulmonary disease (COPD): A group of lung diseases that cause difficulty in breathing
Cystic fibrosis: A condition where thick mucus is produced in the lungs, causing difficulty in breathing and leading to lung damage
Pulmonary arterial hypertension: Increased pressure of blood in the arteries of the lungs
Pulmonary fibrosis: A condition where there is scarring of the lung tissue

Who qualifies for a lung transplant?

Patients are considered for a lung transplant if they suffer from an end-stage lung disease and all other treatment options have failed. As a general rule, a lung transplant is strongly advised only when the patient’s expected survival without the transplant is less than two years. However, the patient must still be healthy enough to undergo the surgery. Overall, lung transplant improves the quality of life.

Eligibility criteria to be a recipient:

Age: The patient should be below 65 years of age
The patient must not have any habits of substance abuse such as smoking, alcohol, and narcotics
Absence of other advanced, uncorrectable disease conditions (coronary heart disease, liver failure, end-stage kidney disease)
A body mass index (BMI) higher than 17
Normal liver function and kidney function
The patient should have no psychiatric disorders, malignancy in the last 5 years, osteoporosis, spinal deformity, or sepsis
The patient must not suffer from any uncorrectable extra-pulmonary infections such as HIV, hepatitis B, and hepatitis C

What medical tests do I have to undergo before the lung transplant?

You will be asked to undergo the following medical evaluation tests to ensure that you are healthy enough to receive the transplant and that your body can cope with the procedure:

Pulmonary function tests
Heart evaluation tests

Bone mineral density test
Chest X-ray
Computed tomography (CT scan) of the chest
Blood test: Complete blood count, bleeding and clotting studies, kidney and liver function tests
Blood and tissue typing, and antibodies present in the blood for matching against potential organ donors
Blood tests and/or skin tests to check for infections
Tests for early signs of cancer

While the tests are usually done as outpatient investigations, you might need to spend 2-3 nights at the hospital in some cases. It is recommended to have someone accompany you to the hospital and make sure they are informed about the processes.

What happens if I fulfill all the criteria for a lung transplant?

If your results from the medical tests are satisfactory, you will be added to a waiting list to receive a transplant. Your position on the waiting list is determined by the following factors:

The type of lung condition you are suffering from
The severity of the lung condition
The likelihood that the lung transplant will be successful

While waiting for the transplant, it is advisable to continue consulting your pulmonologist and adhere to the medication regimen prescribed by them.

When a donor lung becomes available, a suitable candidate from the waiting list will be selected and contacted. The specialists and surgeons will take into consideration the following factors to match the recipient lungs with the donor lung:

If the size of the donor’s lungs matches that of the recipient
Whether the blood groups of the donor and recipient are compatible
Tissue typing: A test that matches the type of donor tissue to the recipient. It is conducted to further ensure that the donor organ will be accepted by the recipient
If the overall health status and age of the donor match those of the recipient

What are the preparations for lung transplant surgery?

A multidisciplinary team of professionals consisting of pulmonologists, transplant surgeons, nurses, a social worker, a psychiatrist or psychologist, a dietician, and an anesthesiologist will guide you through the process. You will also be assigned a transplant coordinator who manages your transplant procedure and follow-up care.

Until the donor lung(s) become available, you will be regularly followed up by the transplant team. This is a good time to further improve your lung function and your overall strength to better withstand the stress of surgery. The dietician and physiotherapist will be closely involved in helping you with this.

You will be alerted when a potential donor is identified and asked to come into the hospital when the donor’s family has agreed to the organ donation. However, remember that it is not uncommon for donors’ families to change their minds at the last minute, so do not be disappointed if this happens or if circumstances change and the donor’s lung is found unsuitable. If the donor organ is suitable, you will have to undergo a blood test comparing your tissue types as well as to find out about potential or previous viral infections.

The transplant team will brief you about the surgery and answer any questions you may have about the same. You will be required to not eat or drink anything for up to 8 hours before the surgery.

You will be required to sign an informed consent form that informs you of the details of the procedure, including the risks and complications involved.

What happens during lung transplant surgery?

Lung transplant surgery is done under general anaesthesia, which means that you will sleep through the whole procedure.

You will be connected to a ventilator to assist your breathing. You may also be connected to a heart-lung bypass machine that ensures the circulation of oxygen-rich blood to all parts of your body during the procedure.

An incision will be made in your chest. The surgeon will access your lungs, replace it with the donor’s lung. The blood vessels and airways will be attached to the donor’s lung.

Following the procedure, the surgical site will be closed and bandages will be placed.

What happens after lung transplant surgery?

After the lung transplant, you will be shifted to the ICU. You will be connected to a ventilator and various tubes that drain urine from the bladder and excessive fluid from your lungs. You will receive medicines and fluids through drips (intravenous administration).

Gradually, you will be shifted to a normal room and eventually discharged to go home.

After being discharged, you may have to frequently visit the hospital for follow-up and monitoring for the initial 1 to 3 months. The frequency of these visits reduces subsequently.

You will be given medicines to suppressing your immune system, which you will have to take for the rest of your life. These medicines are given to prevent the rejection of the transplanted lung.

What are the risks associated with lung transplantation?

Like all procedures, there are some risks associated with the procedure :

Bleeding
Infections
Rejection of the transplanted lung by the recipient’s immune system
Blood clots (deep venous thrombosis)
Blockage of blood vessels and airways to the transplanted lung
Fluid in the lungs
Side effects of medicines given for suppressing the immune system, such as diabetes, bone thinning (osteoporosis), high cholesterol levels, increased risk for infections, and damage to your kidneys, liver, or other organs
Problems at the site where the new blood vessels and airways are attached
It is important to stay in touch with your transplant coordinator, pulmonologist, and cardiothoracic surgeon after the procedure to closely monitor and prevent early signs of the above conditions.