Research shows that transplanting lungs from donors with a history of heavy smoking does not appear to negatively affect recipient outcomes following surgery. The results of this study should give people waiting for a lung transplant what they need most -- hope. The findings shed light on the possibility of reducing waiting-list mortality by maximization of donor selection. The number of available organs for a given recipient will increase. By showing that a positive smoking history in donors has no discernable negative impact on early (up to 72 hours post-transplant) or mid-term(1- and 3- year followup) transplant outcomes, the current policy of refusing donors with a smoking history of at least 20 pack years is clearly questioned.
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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NewYork-Presbyterian Hospital answeredSee All 2 AnswersPatients may receive a single lung (unilateral) or double lungs (bilateral) transplantation, depending on their disease. In cases of chronic lung infection, such as patients with cystic fibrosis, or in severe pulmonary hypertension, both lungs will be transplanted. If the lungs are damaged but not infected, such as in emphysema, the less damaged lung may be left in place.
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NewYork-Presbyterian Hospital answeredWhen a compatible donor organ becomes available, lung(s) must be transplanted into the recipient within about six to eight hours after procurement. Members of the transplant team personally travel to the organ donor's hospital to ensure that the lung(s) are suitable for transplantation prior to surgery; if there is damage, infection, trauma or another problem in the lungs, the transplant surgery will be canceled. While the donor lungs are being examined, the candidate patient simultaneously undergoes a variety of pre-surgical tests and is prepared for surgery.
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NewYork-Presbyterian Hospital answeredPatients who are determined to be suitable candidates for lung transplantation are registered with the United Network for Organ Sharing (UNOS), the non-profit organization that maintains the national patient waiting list and organ matching system.
Depending on the patient's blood type, most patients in the New York region wait an average of six to twelve months before transplantation. During this waiting period, it is critical that patients maintain good nutrition, an exercise program, and overall health, so that they will be strong enough for surgery when a donor organ becomes available. -
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Dr. Lyall A. Gorenstein, MD , Thoracic Surgery (Cardiothoracic Vascular), answered on behalf of Columbia University Department of SurgerySee All 2 AnswersCandidates for lung transplantation are severely impaired in their daily activities. They are without the possibility of alternative medical or surgical therapy and, left untreated, have a poor outlook for long-term survival. Unfortunately, not all of these individuals will benefit from transplantation. Those who have severe systemic diseases or active infections and those who cannot comply with regular follow-up care after transplant should not undertake the operation. -
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Penn Medicine answeredThe lung allocation score (LAS) is an important factor in determining priority for receiving a lung transplant when a donor lung becomes available. The system determines the order of everyone awaiting a lung transplant by their lung allocation scores, blood type and 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 offered first to pediatric and adolescent transplant candidates before they are offered to adults.
The lung allocation system uses medical information specific to each lung transplant candidate. This information includes lab values, test results and disease diagnosis and is used to calculate an LAS from 0 to 100. The score represents an estimate of the severity of every candidate’s illness and the chance of success following a lung transplant. All candidates are placed in order for compatible lung offers according to their score: A candidate with a higher lung allocation score receives higher priority for a lung offer when a compatible lung becomes available.
The supply of donor lungs is limited. The OPTN designed this allocation system to more effectively use the limited number of available donor lungs as well as reduce the number of deaths among people waiting for a transplant. Prior to this system, transplant candidates received donor lungs based on the amount of time they had been on the waitlist. The lung allocation score system is based on scientific data regarding lung transplantation and by drawing on prior experience with many types of people with lung diseases, and offers donor lungs to candidates according to their medical characteristics. -
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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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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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Dr. Lyall A. Gorenstein, MD , Thoracic Surgery (Cardiothoracic Vascular), answered on behalf of Columbia University Department of SurgeryDuring a consultation for lung transplant surgery you will be examined by the transplant pulmonologist, surgeon and coordinator who will also take a detailed medical history and review your medical records as well as recent chest x-ray films and other relevant test results, such as CT scans. The social worker and psychiatrist will each conduct a basic psycho-social evaluation. At that time, the social worker will look into the extent of your social support system – those people who can assist in your care at home following your surgery. The financial counselor will evaluate your medical insurance and determine if the plan provides coverage for your lung transplantation. Often, in collaboration with your social worker, the counselor will work closely with you to ensure that all possible expenses, including cost of your many medications, will be covered, perhaps through new or additional insurance — or sometimes alternative sources.
You and your family will learn about the evaluation process, organ allocation, the potential risks and benefits of lung transplantation, the surgery itself, the post-operative recovery period and the inevitable lifestyle changes, and the mandatory medications you'll be taking for the rest of your life. You will have the opportunity to discuss any concerns you may have. -
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Dr. Lyall A. Gorenstein, MD , Thoracic Surgery (Cardiothoracic Vascular), answered on behalf of Columbia University Department of SurgeryLung transplantation can prolong and dramatically improve the quality of life for patients with severe end-stage, non-malignant pulmonary disease and no alternative treatment options.