How does my doctor decide on a single or double lung transplant?

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. This is determined by a test called ventilation-perfusion scan, which shows the blood flow to different areas of the lungs. Areas that indicate less blood flow are the ones with the greater damage.