Lung Transplant

What you'll learn on this page:

• What Is Lung Transplantation?
• Types of Lung Transplant Procedures
• Steps to Lung Transplantation
• Who Should Have Lung Transplantation?
• Why Lung Transplant Is Performed
• One of the Largest, Most Experienced Transplant Programs in the Country
• Expanding to Meet the Needs of Patients
• Teamwork That Leads to Advancement
• When Transplant Is Not an Option

What Is Lung Transplantation?

Lung transplant is a surgical procedure that replaces 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.

While lung transplant is a life-saving surgery, it’s also a major operation that requires lifelong care. Patients must take powerful immunosuppressant drugs for the rest of their lives to reduce risk of organ rejection.

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Types of Lung Transplant Procedures

Depending on your condition, you may have a single or double lung transplant. You may also have a heart transplant at the same time if you have significant heart damage. Temple transplant surgeons are highly experienced in all types of lung transplant procedures.

Single lung transplant

The transplant team replaces one diseased lung with a healthy lung from a donor. This procedure generally takes 2 to 5 hours. If both lungs are diseased, but only one donor lung is available, the lung with the least function is replaced. Approximately 2/3 of lung transplants performed at Temple are single lung transplants.

Double lung transplant

In the case of a double lung transplant, both diseased lungs are replaced with healthy lungs from a donor. This procedure can take 4 to 10 hours to complete. Approximately 1/3 of lung transplants performed at Temple are double lung transplants.

Heart-lung transplant

Heart-lung transplant is performed when you have serious damage to one or both lungs, and to the heart. During this procedure, one or both diseased lungs and the heart are replaced with the donor’s healthy lungs and heart. This procedure may take 4 to 10 hours to complete.

If you have serious lung disease, a lung transplant can help restore your ability to breathe easier and improve your quality of life. Thanks to advances in techniques, technology and lifelong care after surgery, many patients live much longer than they would without transplant.

In fact, the national 1-year survival rate is about 90%. And at 5 years, the national survival rate is 50%.

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Steps to Lung Transplantation

Evaluation

The first step of getting a lung transplant is finding out if you’re sick enough to need a new lung yet healthy enough to receive a new lung. This involves a careful evaluation by specially trained Temple doctors, nurses, social workers and more who will consider your physical and psychological health and suitability for major surgery.

This expert team will also determine whether another treatment other than lung transplantation is more appropriate for you. In some cases, adjusting medications or a different procedure can improve symptoms and avoid the need for transplant.

Lung transplant can be a life-saving option for many, but it does have risks. During the first year after your transplant, you will be followed closely to watch for complications such as organ rejection and infection. You will also be required to take medicines to help prevent your body from rejecting your healthy organs. These medicines suppress your immune system, which increases your risk for infection.

During your evaluation, the lung transplant team will ensure you understand these risks and the commitment required from you long after your procedure.

Preparation

Once you have been cleared for lung 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. Patients who are very sick may also be placed on extracorporeal membrane oxygenation (ECMO). An ECMO machine may be thought of as a bridge to transplant. It replaces the function of the heart and lungs to help you remain stable until a donor lung becomes available.

You will 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
• Patient's overall health and likelihood of success

An organ procurement organization (OPO) is a non-profit organization that works with UNOS to recover organs from deceased donors. The OPO in the Philadelphia area is Gift of Life.

While you wait for a donor match, you can prepare by doing the following:

Transplantation

You will be contacted when a lung becomes available, and then you must report to the hospital immediately. The lung transplant team will perform a final evaluation to make sure your health is in good condition for transplantation. Once approved, we’ll prepare you for surgery.

Prior to surgery, the donated organ must be examined carefully by the retrieving surgeon to determine whether it’s still functioning properly. This last-minute check is important and improves the likelihood of a successful lung transplant. In some cases, an organ will fail inspection and the transplant will be cancelled.

Once the organ passes 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 minimally invasive technique that’s appropriate for most patients.

After surgery, you will stay in the hospital — first the intensive care unit (ICU) and then a special pulmonary care unit — for about 2 to 3 weeks. Some stays extend for even longer.

During the Procedure

During lung transplantation, you will be under general anesthesia. This means that you’re in a sleep-like state throughout the entire procedure. A breathing tube is placed down your throat to help you breathe. The surgeon begins by making an incision in your chest. If needed, you’re placed on a heart-lung machine. This machine takes over the function of your heart and lungs during the procedure.

The transplant team then detaches the airway and blood vessels from one or both of your lungs. Your diseased lungs are removed from your chest. If you’re having a heart-lung transplant, your heart is also removed. Your donated organs are then put in place and connected to your blood vessels and airway.

When your organs appear to be working properly, the surgical team then sews up the incision. Tubes may be left in your body to help drain any fluid build-up. You will then be transported to recovery.

You may be on the heart-lung machine and monitored around the clock for a few days after your surgery. Once your organs are fully functioning, you will be removed from the heart-lung machine.

Recovery

The recovery period begins immediately after your surgery while you’re still in the hospital, and continues on after discharge. Recovery time depends on many factors, including your health before the procedure and the type of procedure you had.

Although some patients recover faster than others, recovery usually takes about 6 to 8 weeks. During these weeks and months after your lung transplant, you will focus on getting back to your normal routine, including work, hobbies and activities.

It’s important to include family members and other caregivers to assist you during your recovery. You can help them by including them in your doctor visits prior to your lung transplant, and asking them to come with you to your post-transplant doctor appointments. During these visits, they will have an opportunity to ask questions and learn more about what you need to stay as healthy as possible with your new lung.

You may also need the help of a nurse or physical therapist at home, especially during the first few weeks after your procedure. They’ll teach you and your caregivers how to look for signs of organ rejection and infection, and will help you slowly gain your strength with a customized activity program.

Recovery and rehabilitation includes:

• Physical activity
• Medications, such as anti-rejection drugs, antibiotics as needed, and drugs for blood pressure, diabetes and cholesterol
• Home testing/monitoring
• Follow-up appointments for chest X-rays and screening bronchoscopies at 1, 3, 6 and 12 months after transplantation

Our team helps you start and stick to a long-term plan of exercise, diet and mental health to help ensure the best possible outcome.

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Who Should Have Lung Transplantation?

Lung transplants are considered for most people who have 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 from cells. Only patients who have severely damaged lungs that cannot be helped by other therapies are eligible for transplantation.

It’s always better to try all the available treatments with your own lungs before considering a transplant. Testing is still required.

You may be a candidate for lung transplant if:

• No other treatments are possible AND you do not have certain risk factors such as:
  • Body weight too high or low
  • Serious heart, liver or kidney disease
  • Current smoker
  • Inability to follow a long-term health plan

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Why Lung Transplant Is Performed

Lung transplants, including heart-lung transplants, are reserved for those with the most advanced lung and heart diseases. Conditions that may lead to a lung transplant include:

• Interstitial lung disease (ILD)
• Chronic obstructive pulmonary disease (COPD)
• COVID-19
• Pulmonary hypertension
• Bronchiectasis
• Cystic fibrosis
• Sarcoidosis
• Heart and lung conditions that are present at birth

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One of the Largest, Most Experienced Transplant Programs in the Country

Established in 1994, the Temple Lung Transplant Program is one of the most experienced and well-respected in the Mid-Atlantic region. Consider these facts:

• The Temple team has performed over 1,000 lung or heart/lung transplants since its founding.
• Temple consistently ranks as one of the top 5 programs in the nation each year, based on the number of transplants performed.
• Temple’s transplant team includes renowned pulmonologists Dr. Gerard Criner and Dr. Francis Cordova, and transplant surgeons Dr. Norihisa Shigemura and Dr. Yoshiya Toyoda.
• The program is certified by the United Network for Organ Sharing (UNOS) for lung transplantation.

Offering hope for those with the most serious lung diseases

The Temple Lung Center is one of the highest volume transplant programs in the nation. That’s because we consider and accept some of the most challenging and complex cases, including:

• Patients who have been turned down at other centers
• Patients who have esophageal dysfunction
• Older patients
• Patients with a prior history of heart bypass surgery

Our advanced level of training and experience allows us to consider each patient individually. And we continue to lead the nation in new lung transplant innovations, including becoming the first hospital in Pennsylvania to perform lung transplant using the TransMedics Organ Care System. This advanced technology allows the donor lungs to continue functioning during transport in a unique environment that mimics the human body.

Learn more about the TransMedics Organ Care System for Lung, an exciting new technology pioneered by Temple in the Philadelphia area.

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Expanding to Meet the Needs of Patients

Over the past two decades, the Temple Lung Center has expanded to meet the growing need for transplant options for patients with COPD, pulmonary fibrosis or other severe lung conditions.

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.

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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’re also engaged in research aimed at improving lung transplant 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.

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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 candidates for surgery.

Factors that may disqualify a patient from receiving a lung transplant include:

• Recent history of cancer or malignancy
• Significant disease of another organ, such as the heart, liver, kidney or brain
• Chest wall or spinal deformity that may cause difficulty after transplant
• History of substance abuse, including alcohol, tobacco or marijuana
• Inability to participate in post-transplant rehab program

Temple clinicians consider all treatment options, including medical options, as alternatives for every new patient being evaluated for transplant. These options are changing fast — 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.

Find out if you’re eligible for a lung transplant. Request an appointment or call 800-TEMPLE-MED (800-836-7536) to see a pulmonologist today.

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