A lung transplant is a surgical procedure for patients with advanced forms of lung disease that no longer respond to other treatments. Lung transplants involve partially or completely removing a patient‘s diseased lung and replacing it with a healthy lung from a human donor. Sometimes, a patient receives a double-lung transplant. The healthy lung(s) may come from a donor who is under the age of 65, brain-dead but still on life support or from two living donors who each contribute one lobe of a lung.

Lung transplant is a last resort treatment for patients suffering with life-threatening lung disease who are considered unlikely to survive more than a year or two without this surgery. These patients‘ conditions are so severe that, even with medications and breathing devices, they have disabling breathing problems. Reasons for lung transplants include:

• Congenital lung defect
• Cystic fibrosis
• Emphysema or other forms of COPD
• Interstitial lung disease
• Pulmonary hypertension
• Sarcoidosis
• Pulmonary fibrosis

Even for patients desperately in need of lung transplants, there is a waiting list for donor lung tissue. Frequently, patients wait for 2 to 3 years to get to the top of the list. In certain cases, a lung transplant may be contraindicated because the patient is considered too old, infirm, or malnourished to undergo or benefit from the procedure.

Before a lung transplant can be performed, several tests must be administered to type the patient‘s blood and tissue, to evaluate heart and lung function, and to make sure the patient is free of infection or cancer. These tests help to ensure that the patient body‘s is healthy enough for the transplant and that the patient‘s body will not reject the transplanted tissue. Once qualified for a lung transplant, the patient is put on a waiting list prioritized by the severity of the patient‘s lung disease and the likelihood that the transplant will be successful. Patients towards the top of the waiting list for a lung transplant must be ready to go to the hospital for surgery on an immediate basis.

The procedure is conducted under general anesthesia through a surgical cut in the chest. A heart-lung machine is used during the operation, so that the patient‘s body continues to function while the heart is stopped.

During single-lung transplant operation, the incision is made on the side of the chest from which the damaged lung will be removed. This surgery usually takes between 4 and 8 hours. During a double-lung transplant operation, the incision is made across the chest below the breasts. This surgery takes between 6 and 12 hours. When a double-lung transplant is performed, the first lung transplant is completed before the second transplant is done. At times, heart and lung transplants are performed during the same operation.

Whether the operation involves a single- or double-lung transplant, the major blood vessels and air passages of the new lung(s) are stitched to the patient‘s existing blood vessels and airways. Once the donor lobe or organ is sutured in place, chest tubes are inserted for drainage of excess air, blood and other fluid. These tubes remain in place until the new lung(s) expand completely.

There are serious risks to a lung transplant, but such operations are only performed when the danger of dying without the procedure makes taking the risks worthwhile. Risks of a lung transplant include:

• Blood clots
• Postsurgical infection
• Rejection of new lung tissue
• Development of certain cancers
• Difficulties at blood vessel and airway connection sites

The immunosuppression medications administered on an ongoing basis after lung transplant surgery carry their own risks which include:

• Diabetes, high cholesterol or osteoporosis
• Increased risk of infection
• Damage to other organs

Patients are at greatest risk immediately after surgery and for the first year after the transplant.

Immediately after the procedure, patients are in intensive care on a ventilator for several hours for up to several days and remain hospitalized for 1 to 4 weeks. Full recovery from a lung transplant typically takes about 6 months, but patients have to be closely monitored for the remainder of their lives.

Although the life expectancy of patients who have had a lung transplant is shorter than normal, they are expected to have greater longevity than they would have had without the surgery and to experience greatly improved quality of life.