Ideal donor criteria for lung donors vary by hospital, but the criteria generally consist of brain death, age less than 45 to 50 years, minimal smoking history and no evidence of pneumonia or trauma. Donor organs that do not meet all of the ideal donor criteria are sometimes accepted, but not always. While the use of extended criteria donor lungs varies from program to program, most surgeons should be willing to accept non-ideal donors, especially those who are older but otherwise good candidates.
The vast majority of potential donors do not meet the relatively strict donor criteria. As a result, doctors need to continue exploring options that would expand the donor pool and more aggressively utilize extended criteria donors. Much like the general population, the donor pool has continued to grow older.
Lung Transplant
If your breathing problem is so severe that your life is threatened, a lung transplant may be considered. Donor lungs usually come from someone who is deceased. The operation lasts 4 to 12 hours, and in some cases may include a donor heart as well. There is a several week hospital stay followed by close follow-up.
Modern matching techniques and drug therapy have significantly reduced problems with organ rejection, although this is still a possibility. After the operation, patients usually report an improved quality of life. Overall, 83% of lung transplant patients survive the first year, and about 60% survive three years.
Recently Answered
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The Society of Thoracic Surgeons answered -
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The Society of Thoracic Surgeons answered
With a scarcity of lungs available for transplantation, the use of lungs from donors older than age 60 has been shown to achieve reasonable outcomes and should be considered as a viable option. The availability of suitable donor lungs for transplantation continues to be a major obstacle to increasing the number of lung transplants performed annually. Research that explores the means of expanding the donor pool is of critical importance.
In a study of 14,222 lung transplant recipients age 18 years or older between January 2005 and June 2014, 26 percent were age 50 years or younger, with 2 percent receiving lungs from donors older than age 60. Among this group of younger people who received older donor lungs, there was no significant difference in five-year survival when compared to people who received lungs from younger donors. Younger people who received older donor lungs experienced much better outcomes when a double versus a single transplantation was performed. The study showed that in younger people who received a single lung transplant using organs from older vs. younger donors, there was a lower five-year survival (15 percent vs. 50 percent). However, with a double lung transplant, there was no significant difference in five-year survival (53 percent vs. 59 percent).
This study demonstrated that reasonable outcomes are possible with the use of advanced age donors. -
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Dr. Lyall A. Gorenstein, MD , Thoracic Surgery (Cardiothoracic Vascular), answered on behalf of Columbia University Department of SurgeryYour transplant team will include attending surgeons and full-time cardiac anesthesiologists, who jointly lead the team that includes surgical residents, perfusionists, physician assistants, and nurse practitioners. They are further supported by a sophisticated cardiothoracic intensive care unit, where you receive one-on-one nursing care, under the direction of your surgeon and pulmonologist. -
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Dr. Lyall A. Gorenstein, MD , Thoracic Surgery (Cardiothoracic Vascular), answered on behalf of Columbia University Department of SurgerySee All 2 AnswersA transplant team will conduct a careful and comprehensive evaluation of your physical condition. Necessary tests are performed, including pulmonary function testing (PFT), x-rays and blood tests. Your dental health and bone strength are evaluated. You meet with the team's coordinator, social worker, psychiatrist, and financial counselor to help you understand and find ways to minimize the personal impact transplantation would invariably have on you and your family. Results are generally complete within a few days of the examination. Then, the team analyzes all the test data and consultation results to determine if transplantation is the correct therapy for you. This evaluation phase is typically completed within 60 days. At the end of the evaluation, an individualized action plan is created for you. If you are accepted as a transplant candidate, you are registered on the organ recipient waiting list of the United Network for Organ Sharing. If transplantation is not right for you, alternative therapies are recommended. Note to reviewer: I'm not sure how this is different from a lung consultation; see the question after the next one.
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Dr. Lyall A. Gorenstein, MD , Thoracic Surgery (Cardiothoracic Vascular), answered on behalf of Columbia University Department of SurgeryStandard treatment for interstitial lung disease is intended to improve symptoms and slow progression of the disease. Corticosteroids and cytotoxic drugs aim to reduce the inflammatory reaction and prevent the scarring and thickening of lung tissues. Standard treatment for IPF is intended to improve symptoms and slow progression of the disease. Corticosteroids and cytotoxic drugs aim to reduce the inflammatory reaction and prevent the scarring and thickening of lung tissues. Lung transplantation has been successful as a treatment of last resort.
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Dr. Lyall A. Gorenstein, MD , Thoracic Surgery (Cardiothoracic Vascular), answered on behalf of Columbia University Department of SurgeryThe diagnosis of interstitial lung disease has become significantly more accurate as a result of video-assisted thoracic surgery (VATS). Multiple areas of the lung can be biopsied to determine the presence of this disorder without the need for a large incision.
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NewYork-Presbyterian Hospital answeredSee All 2 AnswersNot everyone with end-stage pulmonary disease will be eligible for transplantation. The first goal of the program is to determine whether lung transplantation is the best option for each patient. The evaluation process may be performed in patients who meet certain criteria:
- No acute and/or critical illness
- No significant other organ dysfunction, such as severe heart, kidney or liver disease
- No active cancer within last two to five years depending on the type and stage of cancer
- Abstinence from cigarette smoking, heavy alcohol use and drug addiction for at least six months
- Track record of compliance with follow-up visits and medications
- No significant and active psychiatric problems
- Current body weight with a BMI of less than 30
- Ability to pass a standard six-minute walk test and participate in pulmonary rehabilitation program
- No HIV infection, or chronic hepatitis
- No infection with certain difficult-to-treat micro-organisms
The evaluation process includes an initial screening, multiple tests and consultations, and laboratory assessment. Candidates for transplantation are evaluated by members of the transplant team including the transplant pulmonologist, surgeon, transplant coordinator, psychiatrist, social worker, financial counselor, and in some cases, a cardiologist and gastroenterologist.
The complete outpatient testing and consultation process requires three to four full days at the hospital, which may be scheduled during the course of four to six weeks. The test results are then reviewed with the patient and discussed at the multi-disciplinary team meeting to make a decision. -
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The Society of Thoracic Surgeons answeredLungs from carefully selected donors with a heavy smoking history can be used with good results in adult, double-lung transplants, according to a study released at the 49th Annual Meeting of the Society of Thoracic Surgeons. Transplants from heavy smokers composed 13% (766) of the double-lung transplants studied. A heavy smoking history is defined as at least a pack a day for more than 20 years.
The researchers found that patients who received lungs from carefully selected donors with a history of heavy smoking had similar short- and medium-term survival compared with patients who received donor lungs from non-heavy smoking donors. Lung function was not worse when using heavy smoking donors, and the number of deaths due to malignant cancers was not different.
Lung transplantation has been shown to be an effective treatment for end-stage lung disease; however, this treatment is limited by a critical shortage of donor organs. Transplantation guidelines recommend against using lungs from donors with a history of heavy smoking, but this study finds that lungs from a heavy smoker may be accepted by a transplant surgeon in special situations. For example, a surgeon may choose to transplant lungs from a healthy donor who has good lung function despite heavy smoking, or lungs may be accepted from a less than ideal donor for a very sick patient. This may help decrease the shortage of donor lungs and decrease waiting list mortality. -
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Penn Medicine answeredEvery transplant involves two operations: The first operation involves a transplant surgeon who goes to the donor's hospital and recovers the lungs. The other operation transplants those lungs into the recipient.
Lung transplant surgery typically takes up to six hours, though people are usually in the OR much longer. Before the surgery begins, care is provided in the operating room by nurses and an anesthesiologist. They place intravenous lines and provide medication to help recipients relax. The surgery does not begin until the surgeon recovering the donor lungs calls to report that the lungs are healthy and in good condition to transplant. Once the lungs have been accepted, recipients are prepared for transplant surgery.
During the surgery, the new lung is placed in the chest and connected to the bronchus (airway), the pulmonary artery (the vessel that carries blood to the lungs) and two pulmonary veins (which carry blood from the lungs back to the heart) to each lung. The surgical incision is either in the middle of the chest or on the side of the chest under the arm. -
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See All 2 AnswersIn 2005, the U.S. Organ Procurement and Transplantation Network (OPTN) and its non-profit funding agency, United Network for Organ Sharing (UNOS), changed the nation's method of allocating organs to transplant candidates. The new method, involving a scoring system to help determine position on the organ waiting list, replaced an older system allocating organs on a first-come first-serve basis.
Under the new lung allocation system, every lung transplant candidate age 12 and older receives an individualized lung allocation score. The lung allocation score reflects both the seriousness of each candidate's medical status before transplant and the likelihood of a successful transplant. It is an important factor in determining priority for receiving a lung transplant when a donor lung becomes available. The system determines the order of all individuals awaiting a lung transplant by their lung allocation scores, blood type, and the geographic distance between the candidates and the hospital where the lung donor is located. Age also plays a role because lungs from pediatric and adolescent donors are now offered first to pediatric and adolescent candidates before they are offered to adults.
The score utilizes a complex clinical calculator derived from clinical predictors of survival that is reported on a scale of 0 to 100 (0 is least ill and 100 is the most ill). In the first year the new system was in place, over half of lung transplants were performed in patients with scores less than or equal to 40. Additional information on transplants performed each year is available through the published reports at the OPTN website.
OPTN maintains a centralized computer network linking all transplant centers and regional organ procurement organizations (OPOs), which identify potential organs for transplant and coordinate with the national network. This computer system is accessible 24 hours a day, seven days a week, with organ placement specialists available round the clock.