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Lung Transplantation “Need to Knows”

Posted Feb 21 2013 2:25pm

Lung transplant is considered in individuals who suffer from severe lung damage usually due to chronic lung disease.  Although lung transplant can restore easier breathing, and provide a longer life, it is not without complications.  There are both single and double lung transplants.  There are advantages to both.  The physician and transplant team will decide which will be best for each person based upon each individual set of circumstances

Most people suffering from severe, or end-stage, pulmonary disease may be considered for lung transplant.  It may also be considered for those patients who can no longer enjoy life.  People with conditions such as COPD, emphysema, chronic bronchitis, pulmonary fibrosis, cystic fibrosis, and even pulmonary hypertension are those who could be taken into consideration for this difficult and intricate surgical procedure.  However some, with lifestyle choices such as continued smoking, or at an age greater than 65 may not qualify, depending upon the circumstances.  Age is one of the greatest determining factors in successful outcomes.  Doctors may also not recommend a patient for lung transplant if there is significant heart, kidney, or liver disease, alcohol or drug abuse, or chronic infections or cancer present in the patient.

The evaluation process for this surgery is long and complicated.  The patient must first be determined by their physician to meet general requirements.  Upon the physician deciding it is an option that is open to a particular patient, the request is sent to a transplant center, where a group of staff will meet to review the case.  This may take at least weeks, and up to months.  This will include meeting with, or speaking to, the patient to gather additional information over the course of the decision making process.  Questions such as the patient’s condition, family and social support, financial situation, psychological condition, and co-morbidities (additional medical conditions) will be taken into consideration along with PFT results, cardiac tests, chest x-ray results, CT scans, and liver and kidney function.  Blood type and antibodies present in the blood are also determined for matching to potential donors.  Sometimes a bone mineral density test is also performed.

Once the testing and application process has been completed, and the conclusion that the patient is a good candidate for transplant, his/her name will be added to national organ recipient list – aka transplant list.  The place on the list is determined by the Lung Allocation score.  This score is calculated to predict two things – how long the patient is determined to live without the transplant, and how long the patient is expected to live after the transplant.  People with higher scores are places higher on the list, which translates to a greater urgency for transplant.

In many cases, the patient will be told to expect a phone call, or will be given a pager which needs to be constantly available to the recipient.  A phone call or buzz on the pager could occur at any time during the day or night.  When compatible donor lungs become available, the candidate will be contacted and is expected to go to their transplant center immediately to prepare for the surgery.  If the patient lives close enough, driving to the hospital is advised.  If the patient lives too far from the hospital to drive, arrangements for travel will be made.  They will have most likely been told not to eat or drink anything after the phone call is received, in order to have an empty stomach for surgery.  It is also important to have a bag prepared and plan ahead for this to help reduce anxiety and delay.  Having a plan in place for when the phone call comes will help all involved, regardless of their role, and will help the patient remain calmer knowing that their homes, children, pets, etc are in order and things are being taken care of in their absence.

Members of the surgical team travel all over the country to examine the deceased donor’s organs for viability – to make sure they are suitable for transplant.  If they determine that the organs are “healthy” enough for transport, surgery will begin as soon as possible on the recipient while the lungs are in transit to the recipient’s location.  This is because, even though the organs are protected and well taken care of during transport, time is of the essence.  Preparation is essential.  Remember to let the medical staff know if a cold, fever, infection, or anything outside of the normal is present.  While this may cancel your surgery, canceling is a better option than risking a transplant under already compromised circumstances.

When prepping for the surgery, the patient will be asked to empty their bladder, wear a hospital gown, remove any dentures or plates, remove contacts, eyeglasses, and jewelry, as well as hair pins, nail polish, and make-up.

During this approximately 6 hour surgery, and depending upon which transplant option the recipient is scheduled for, either single or double transplant, an incision will be made on either one side of the chest,  follow the entire width of the chest, or be two separate incisions on both sides of the chest.  During the surgery, the patient will most likely be placed on cardiopulmonary bypass, a machine the patients’ blood flows through to ensure oxygen rich blood is pumped back into the body.   Once the new lungs are placed, blood vessels are secured and viable, and air can flow through the new lungs, the bypass will be shut off and the blood will flow through the heart, and air through the new lungs.

The surgery is over – the journey has just begun.  While a lung transplant can take away breathlessness and improve quality of life, recovery from this fragile surgery and efforts to help the recipient’s body accept the new organs is a delicate process.  The journey will begin in the ICU, where the patient will receive 24 hour care by specialized professionals trained in the unique needs of transplant patients and their families.  The amount of time spent in the ICU depends upon the individual circumstances and complications that may/may not occur.  In the operating room the patient will have been put on a ventilator, and a tube will have been placed in the trachea, through the mouth.  This ventilator will breathe for the patient during this time, and will be set according to the specific needs of the patient.  It will be monitored constantly, and adjusted as needed, to ensure accuracy and optimal precision in each breath.  This will remain for a time in the ICU while the patient recovers.  There will also be a “feeding tube” placed into the stomach to drain stomach secretions, and nutrients will be placed in an IV to ensure proper nutrition takes place.

Fighting the immune system against rejection of the new organs can sometimes be difficult, and some degrees of complications are impossible to avoid.  The recipient will likely be prescribed medication to improve acceptance of the organs, which can cause side effects.  These can include things such as diabetes, kidney damage, and increased likelihood of infections.  However, even with the complications that can and will be encountered after this surgery, most patients will tell you they have no limitation on their physical activity, and many return to and continue to work after healing.

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