Lung transplantation is a remarkable procedure. The decision to perform a single or double lung transplantation depends mainly on the type of lung disease the patient has. If the disease involves infection (e.g. cystic fibrosis), then both lungs must be transplanted. This is because the anti-rejection medications (immunosuppressants), which are necessary for all transplant patients, suppress the immune system and, therefore, increase risk of infection. However, if the lungs are damaged but not infected (e.g., emphysema), one lung can be left in place. Patients with pulmonary hypertension do better if they have a double lung transplant. Age can also be a factor. Older adults tend to have more problems following a double lung transplant because it is a longer and more complex surgery. Therefore, they do better with a single lung transplant, when possible.
In the case of a single lung transplant, the lung that is most damaged is the one that is transplanted. While the patient is under general anesthesia, the surgeon makes an incision in the chest. If it is a single lung transplant, the incision is made on the right or left side, depending on which lung is being replaced. A double (bilateral) transplant requires an incision across the chest beneath the breast area.
The donor organ, which has been chilled to preserve it until transplantation, must be transplanted within six hours after being removed from the donor. As soon as the new lung(s) arrives in the operating room, the recipient’s lung is immediately removed and the donor organ is placed in the chest cavity. When it is a double transplant, the organ with the poorest function is removed first and replaced.
Once the new organ is in place, the surgeon connects the pulmonary artery, pulmonary vein and the main airway (bronchus) of the donor organ to the patient’s vessels and airway. Drainage tubes are inserted to drain air, fluid, and blood out of the chest for several days to allow the lungs to fully re-expand.
The surgery can take from four to eight hours, depending on whether it is a single or double lung transplantation and if complications occur. Upon completion of the surgery, you will be taken to the Surgical Intensive Care Unit (SICU-B) and closely monitored for complications.
You will be on a ventilator (breathing tube), with multiple intravenous access devices and monitoring devices along with medications to support the lungs. Usually, you will be removed from the ventilator and out of bed within 24-48 hours postoperation.
Transplant education is started within a few days with you and your support team. For more in depth information refer to the “Lung Handbook” provided by the International Transplant Nurses Society
SURGERY TIME: Entire surgical process usually takes 6-12 hours. These are average times, and delays are common.
TIME IN THE HOSPITAL: 14-21 days
Will your new lungs work right away?
Most lungs work immediately. Sometimes in rare situations, there is a delay and the lung function and it may require additional mechanical support to come from the operating room. This is usually temporary and takes a few days to get stronger. During this time you will remain in the ICU and be observed very closely.