Lungs are vital organs that draw in the oxygen needed for cellular function and expel carbon dioxide, a waste product of cellular function. If a person’s lungs become too diseased or damaged to allow for an adequate intake of oxygen and if there is no other possible treatment available, a lung transplant may be performed to replace one or both of the lungs. During lung transplant surgery, the diseased lung or lungs are removed and replaced with healthy donor lungs. Most lung transplants are cadaveric, meaning the replacement lung comes from a deceased organ donor. It is possible to remove a part of the lung from a healthy, nonsmoking adult and transplant this lobe in a procedure called a living transplant. Both donor and recipient can live a healthy life with partial lungs.
There are different types of procedures used to transplant lungs. The type of procedure used is determined by the recipient’s condition. When only one lung is replaced, the procedure is simply called a single lung transplant. Transplanting two lungs is performed using either a double lung, bilateral sequential or bilateral single procedure. A heart-lung transplant takes both lungs and the heart from a single donor and transplants all three into the recipient.
Who Qualifies for a Lung Transplant?
There are strict guidelines for any organ transplantation. A potential lung recipient must undergo a complete series of medical and psychological tests and procedures to determine eligibility. Findings from this screening process are also used to match patients with a donor lung or lungs. Because donor organs are scarce, these tests also help determine the likelihood of transplant rejection. Patients whose bodies are more likely to reject the transplanted organ are usually considered ineligible for transplant. Other factors that can prevent a patient from receiving a lung transplant include:
- Chronic, untreatable infection
- Cancer that has spread (metastiized) from any part of the body to any other part
- Conditions such as severe cardiac problems that may prevent the patient from surviving the surgery
- Serious non-lung-related conditions that show no chance of improvement
- A patient’s refusal or inability to comply with the very rigid treatment regimen required with an organ transplant
How are Donor Lungs Found?
The United Network for Organ Sharing (UNOS) is responsible for distributing all transplanted donor organs in the United States. UNOS’ database system collects and analyzes all information relevant to a lung transplant waiting list, organ matching and transplant surgeries. The data for every patient awaiting a lung transplant is in this system and is updated constantly with incoming information from the patient’s medical team. To ensure fairness, the conditions of patients needing a lung are ranked according to the urgency of their need with those most in need receiving first priority for donor lungs.
When a lung(s) becomes available, its tissue characteristics are entered in the database. The system then begins matching the lung to a recipient, starting with those whose need is the most urgent. Having a more urgent need does not guarantee a match. There must be a tissue match between the donor organ and the recipient, so a lung may go to someone whose urgency ranking is lower on the list.
How Does a Patient Get on a Waiting List?
If you may be in need of a lung transplant your transplant team at Florida Hospital will perform a comprehensive set of tests and procedures. These tests will help gauge your body’s ability to accept a new lung without rejection and the urgency of your need. This screening process also provides your medical team with the information needed for the UNOS database. The evaluation can include:
- Psychological and social evaluation
- Diagnostic tests, including:
o Sonography (ultrasound)
o Computed tomography (CT or CAT scan)
o Pulmonary function tests
o Dental examinations
o Pap smear
o Gynecological evaluation
- Blood tests
- Lung biopsy
How Long Does a Patient Wait for a Donor Lung?
Patients waiting for a cadaveric transplant (using a lung from a deceased person) are placed on UNOS waiting list. The average wait for a single lung is two years and those in need of two lungs wait an average of three years. However, there is no guarantee that a donor lung will be available in time to save a patient’s life. Patients who are unable to wait for a donor lung may be candidate for a living-donor transplant.