A lung transplant (LTx) is a complex surgical procedure that replaces one or both of a patient’s diseased lungs with healthy lungs, typically from a deceased donor. This intervention is reserved for individuals with end-stage pulmonary disease who have not improved despite maximum medical treatment. The goal of a lung transplant is to extend life expectancy and significantly improve the quality of life. It requires a comprehensive evaluation to ensure the patient is physically and psychologically prepared for the demanding journey.
Medical Conditions That Require a Lung Transplant
Transplantation is considered when chronic lung conditions progress to end-stage lung disease, resulting in life-threatening respiratory failure because the lungs cannot effectively supply the body with oxygen. Chronic Obstructive Pulmonary Disease (COPD), including emphysema, is a frequent indication, especially when lung function is severely compromised. Idiopathic Pulmonary Fibrosis (IPF), which causes progressive and often irreversible scarring of the lung tissue, commonly necessitates a transplant. Cystic Fibrosis (CF) is a leading reason for transplantation in younger patients due to widespread airway damage from persistent infection. Pulmonary Hypertension may also require LTx when high blood pressure in the lung arteries strains the heart and medical therapies fail.
Determining Eligibility for Transplant
Assessment Criteria
The process of becoming a transplant candidate involves a rigorous assessment of factors beyond the primary lung disease. Transplant centers use strict criteria to select candidates who have the highest likelihood of surviving the procedure and adhering to the intensive post-operative regimen. While a traditional age limit of 65 years for double lung transplants was common, many centers now evaluate patients individually, even those slightly older, provided they are otherwise healthy.
Physical and Psychological Readiness
Candidates must demonstrate adequate function in other major organ systems; severe kidney or liver disease can be contraindications due to the medications required post-surgery. A thorough psychosocial evaluation assesses the patient’s psychological stability, understanding of the commitment, and the presence of a reliable support system at home for managing complex recovery and follow-up care.
Compliance and Lifestyle
Compliance with medical advice is paramount, requiring a documented history of adherence to treatment plans before being listed. Requirements include a mandatory, verifiable period of abstinence from all forms of nicotine and substance use, often for at least six months. Nutritional status is also carefully reviewed, as both morbid obesity (a Body Mass Index above 30-35) and severe malnutrition can increase the risk of complications. The overall assessment ensures the patient possesses the physical reserve and mental readiness to succeed.
The Path to Surgery
Once eligible, the evaluation continues with diagnostic tests like pulmonary function tests and imaging scans to finalize listing data. The patient is then placed on the national waiting list, managed by a centralized computer system. Donor lungs are allocated using the Composite Allocation Score (CAS), which replaced the Lung Allocation Score (LAS) in the United States.
Organ Allocation
The CAS prioritizes candidates by balancing medical urgency and the projected long-term survival benefit from the transplant. Additional factors include blood type compatibility, height, and the distance between the donor hospital and the transplant center. A higher CAS score means a higher priority for the next compatible organ.
Waiting and Procedure
The waiting time is highly variable, ranging from days to months, depending on the patient’s score and physical match. When an organ becomes available, the patient must be ready immediately. Surgery involves either a single lung transplant or a double lung transplant. The double lung procedure is now the most common, preferred for diseases like cystic fibrosis, and typically takes six to twelve hours.
Life After the Procedure
The immediate post-operative period involves a stay in the Intensive Care Unit for monitoring, followed by recovery and rehabilitation in a dedicated transplant unit. Physical therapy and pulmonary rehabilitation are initiated quickly to help the patient regain strength and optimize the function of the new lungs. Patients are discharged with a complex medication schedule that requires strict adherence.
Lifelong immunosuppressive medications are necessary to prevent the immune system from attacking the new organ. These anti-rejection drugs increase the risk of infection and can cause side effects like hypertension and kidney issues. Patients face risks of acute rejection and chronic rejection, known as Chronic Lung Allograft Dysfunction (progressive scarring of the small airways). Despite these challenges, a lung transplant substantially improves breathing and activity level, with approximately half of all recipients still alive five years after the procedure.