What is Lung Transplantation?
Lung transplantation involves surgically replacing one or two diseased lungs with healthy lungs, usually from a deceased donor. In some cases, a heart transplant is performed at the same time. New lungs help the body get the oxygen it needs to survive. Following surgery, most patients must take powerful immunosuppressant drugs for the rest of their lives to reduce the risk of organ rejection.
The main steps in the lung transplant process are:
- Evaluation: The first step to transplant is finding out if you are sick enough to need a new lung yet healthy enough to receive a new lung. This involves a careful evaluation by specially trained Temple staff members who will consider your physical and psychological health and suitability for major surgery. This team will also determine whether another treatment other than transplantation is more appropriate for you. In some cases, adjusting medications or a different procedure can improve symptoms and avoid the need for transplant.
- Preparation: Once you have been cleared for transplant, you will prepare for the operation and wait for a donor match. During this period, you may need to reduce certain risks or undergo further tests or procedures. You will also be added to the national waiting list for a donor lung. The list is administered by the United Network for Organ Sharing (UNOS). As organs become available, UNOS makes the most appropriate match based on factors such as blood type, organ size, distance between donor organ and patient, and the patient's overall health and likelihood of success.
- Transplantation: When a lung becomes available, you are contacted and must report to the hospital immediately so that the transplant team can perform a final evaluation to make sure you are still in good condition for transplantation. Once approved, you will be prepared for surgery. Prior to surgery, the donated organ must be examined carefully by the retrieving surgeon to determine whether it is still functioning properly. This last-minute check is important and improves the likelihood of a successful transplant. In some cases, an organ will fail inspection and the transplant will be cancelled. Should the organ pass inspection, the transplant team will begin surgery. Depending upon the complexity of the case, surgery can last from 4 to 12 hours. The operation usually involves a full sternotomy (splitting of the breastbone), although Temple surgeons have developed a new minimally invasive technique that is appropriate for some patients. After surgery, you will stay in the hospital (first the ICU and then a special pulmonary care unit) for about 2 to 3 weeks. Some stays extend for even longer.
- Recovery: Soon after surgery, you will begin education and physical rehabilitation. This continues after you leave the hospital. Transplant patients require approximately 6 to 8 weeks of recovery time. Recovery and rehabilitation includes: physical activity, medications (e.g., anti-rejection drugs, antibiotics as needed, and drugs for blood pressure, diabetes, and cholesterol), home testing/monitoring, and follow-up appointments for chest X-rays and screening bronchoscopies at 1, 3, 6 and 12 months after transplantation. (Bronchoscopy with biopsy is an exam and sampling of the lung through a small scope inserted through the nose to test for possible signs of rejection or infection.) The Temple transplant team also helps you start and stick to a long-term plan of exercise, diet, and mental health to ensure the best possible outcome.
Who Should Have Lung Transplantation?
Lung transplants are a last-resort treatment for irreversible lung failure brought on by disease. Lung failure occurs when the lungs are damaged and unable to transfer oxygen and carbon dioxide to and away from cells. Only patients who have severely damaged lungs that cannot be helped by other therapies are eligible for transplantation. It is always better to try all the available treatments with your own lungs before considering a transplant.
If no other treatments are possible, and if the patient does not have certain risk factors (e.g., body weight too high or low; serious heart, liver, or kidney disease; current smoker; inability to follow a long-term health plan), then they may be a candidate for lung transplantation. Testing as described in the previous section is still required.
The conditions that most commonly lead to end-stage lung disease requiring transplantation include:
- Chronic obstructive pulmonary disease (COPD), including emphysema
- Pulmonary fibrosis (including IPF)
- Pulmonary hypertension
- Cystic fibrosis
Why Choose Temple?
Established in 1994, the Temple Lung Transplantation Program is one of the most experienced and well-respected in the Mid-Atlantic region. Consider these facts:
- The Temple team has performed over 540 lung or heart/lung transplants since its founding.
- Temple consistently ranks as one of the top five programs in the nation each year, based on the number of transplants performed.
- Temple’s transplant team includes renowned pulmonologist Dr. Gerard Criner and transplant surgeons Drs. Norihisa Shigemura and Yoshiya Toyoda.
- The program is certified by the United Network for Organ Sharing (UNOS) for lung transplantation, and is Joint Commission-certified for lung volume reduction surgery (LVRS).
Expanding to Meet the Needs of Patients
Over the past two decades, the Temple Lung Center has expanded to meet the growing regional need for transplantation options for patients with COPD, pulmonary fibrosis, or other severe lung ailments. Today, the program consists of a dedicated team of surgeons, pulmonologists, immunologists, psychologists, nurse specialists, technicians, counselors, nutritionists, and financial coordinators. This team is led by internationally renowned transplant surgeon Yoshiya Toyoda, MD, PhD, who pioneered the antero-axillary approach in lung transplantation, a minimally invasive form of surgery that avoids many complications of the standard procedure.
Teamwork that Leads to Advancement
Temple surgeons collaborate with Temple pulmonologists to evaluate patients for potential procedures (transplantation or other) and to coordinate pre- and post-surgical tests and procedures. They are also engaged in research aimed at improving lung transplantation outcomes, including studies on preservation of donated organs, immunosuppressive medications, antibiotic use, echocardiographic evaluation of patients, alternative therapies for wait-listed patients, and minimally invasive therapies.
When Transplant is Not an Option
While there is no question that transplantation can be a life-saving step for a patient with advanced lung disease, not all patients are ideal candidates for surgery. Temple clinicians consider all treatment options, including medical options, as alternatives for every new patient being evaluated for transplantation. These options are changing fast and Temple pulmonologists and critical care specialists can evaluate the pros and cons of the full range of novel drug therapies, biotech agents, devices, special procedures, and surgeries for each patient, depending on their unique clinical situation and preferences.