Lung Transplant : Type, Requirements, Procedure, And Everything To Know

• A recipient : a recipient is a person with end stage lung diseases for which no medical or surgical therapy is available and has a limited chance of survival if left untreated. The diseases which lead to this situation have already been described above.

• Donor: the donor could be Cadaveric (brain dead or cardiac death as mentioned above) or live related (as mentioned above)

• The Process of transplantation: carried out by an accredited lung transplant centre.

The steps involved in the lung transplantation process are as below:

• Recipient identification : a person with end stage lung disease is identified by his treating physician and referred to a lung transplant centre.

• Recipient work-up: the above patient is evaluated by a transplant pulmonologist at the lung transplant centre and if he meets the selection criteria for lung transplant, he is admitted for a series of tests and examinations to evaluate his physical and mental fitness for the same.

• Recipient notified on the NOTTO site: after complete workup, patients who are considered eligible and are fit for lung transplant and where the family consents for the same, the patient is notified on the lung transplant recipient waiting list of the state or regional of national transplant organization (NOTTO / SOTTO / ROTTO). These are government agencies which control and coordinate the distribution of organs as per law.

• Recipient relocation: after being notified on the waiting list the recipient is requested to move to the same city as the lung transplant centre. The medical treatment, nutritional support and physiotherapy is continued under the supervision of the transplant team.

• Donor Offer: whenever, the family of a brain dead or a cardiac death person consents to organ donation, the details of the donor are provided to the state of regional or national organ transplant organization which matches it with the waiting list and allocates the organ using blood group, size matching and geographical location as the criteria. An offer regarding the same is made to the team at the recipient hospital.

• Recipient - donor matching and acceptance of the offer: Once the team at the recipient centre receives a lung offer from the transplant organization, they connect directly with the team at the donor hospital and look critically at the blood group and size matching and also look at the oxygenation (i.e. blood gases) and CT Scan of the lungs to check the fitness of the lungs on offer. This is a very important step and needs a lot of coordination between the teams at the donor hospital and the recipient hospital. The provisional acceptance is given on the basis of this telephonic exchange of information although, the final call on accepting the lungs on offer is made on the table when the recipient hospital team reaches the donor hospital, looks at the blood gases and bronchoscopic pictures and opens the chest of the donor and looks at the lungs physically

• Removal of Donor Lungs: after accepting the lungs on offer (as per steps mentioned above), the recipient hospital surgeons team removes the lungs from the donor (called explantation) as per a laid down procedure and packs them into an ice box for transport back to the recipient hospital again as per a laid down procedure.

• Recipient admission into hospital: while the recipient team is moving towards the donor hospital, another team at the recipient hospital admits the recipient and prepares him for the transplant process. As soon as the lungs on the offer are accepted (and also depending on the travel time from the donor hospital to the recipient hospital) the recipient is wheeled into the operation room and anesthetized and operation started .

• The Transplantation of the Lungs : as soon as the recipient hospital team arrives in the operation room with the donor lungs, the recipient’s native lungs are removed from his body and the donor lungs are implanted in a sequential manner.

• Post operative Care: As per the current evidence, most of the recipients are put on artificial support (ECMO) during the transplantation process. This has been shown to help in the quick recovery of the transplanted lungs. This kind of ECMO support is slowly withdrawn and thereafter, the ventilator support to the recipient is slowly withdrawn in the postoperative period over the next few days. Depending on how the implanted lungs function, the recipient needs to be in ICU from a few days to a few weeks. Thereafter, they are shifted to the ward and managed accordingly.

• Immunosuppression and Infection prevention medicines: as the donor lungs are considered a “foreign body” by the immune system of the recipient, it mounts a massive immune response which destroys the donor lungs very fast. Inorder to prevent this from happening the recipient is started on Immunosuppression i.e. medicines to reduce the immune response of the recipient. These medicines are started before the operations and are continued post operatively, forever. While they reduce the immune response from the recipient body and allow the donor lungs in his/her body and function, it comes at the cost of markedly decreased resistance to various bacteria, viruses and fungus present in the ambient air. Thus, the recipients are at a high risk of various infections because of being immunosuppressed. To face this risk they are given various antiviral and anti-fungal medicines as a preventive measure and also advised certain physical measures to limit exposure to these pathogens. Thus, infections are a major issue in the long term postoperative period of these patients due to Immuno-suppression medicines. Treating doctors have to walk a tightrope between immunosuppression medicines dosages and the risk of infections.

• Long Term follow-up: rejection and infection are the two major issues in the long term follow-up of these patients for which the patient needs to visit the hospital on a regular basis, undergo various tests at regular intervals and take immunosuppression and infection prevention medicines on a regular basis, life long. This does impose a recurring monthly expense as well as inconvenience to the recipient and must be understood well and accepted before the proposed recipient and family accepts the lung Transplantation offer from the treating doctors.

The surgery for Lung Transplant tumour  can be done best by VATS/Robotic method which has been our speciality for over a decade.

FAQs

Q. What different lung transplant procedures exist?

Single lung transplants (the replacement of one lung) or double lung transplants (replacing both lungs) are the two main forms of lung transplants. The decision is based on the unique situation and the transplant teams suggestion.

Q. What happens during a lung transplant?

The procedure for a lung transplant is intricate and may last for many hours. The diseased lung or lung(s) is/are taken out during surgery, and the healthy donor lung(s) is/are carefully placed. Patients are initially put on a ventilator and then under strict observation.

Q. What happens after a lung transplant in terms of recovery?

Recovery differs from individual to individual but frequently entails a few weeks in the hospital. To guarantee a positive outcome, medication management, rehabilitation, and routine follow-up care are crucial.

Q. What are the risks and issues associated with lung transplantation?

Risks associated with lung transplant surgery include infection, rejection of the donor organ, and issues with the drugs taken to prevent rejection. Chronic rejection and adverse consequences from immunosuppressive medications are examples of long-term problems.

Q. What is the typical lifespan of a transplanted lung?

While the lifespan of a transplanted lung differs many patients may anticipate that with the right care, the new lungs will continue to function effectively for at least 5 to 10 years, if not longer. Its important to follow up frequently and to take the recommended medications as directed.

Q. Can I decide the time of my surgery for a lung transplant?

Patients typically have little control over when their transplant operation will take place. It depends upon when an appropriate donor organ becomes available as well as once the transplant team determines that the timing is correct to do the surgery. The timing is meticulously planned to guarantee the patients optimal outcome.