Lung Transplantation

Before you go in for your medical evaluation, there are several steps you should take to ensure you’re in the best possible position to be accepted as a transplant candidate:

• Demonstrate compliance. For you to be an optimal candidate for lung transplantation, all your other organ systems have to be functioning adequately. Your transplant team will want to see a habit of compliance with your medical care. Make sure your physicals, vaccinations, and dental care are up to date. If you have comorbidities (other diseases in addition to your lung disease), take your medications as prescribed, keep follow-up healthcare appointments, and follow any recommended medical diets. 
  

• Exercise. Transplant centers require a minimum level of endurance, which can take time to build up. Get started on your plan now. If oxygen needs or access issues prevent you from enrolling in exercise programs at a gym, ask your healthcare provider if a referral for pulmonary rehabilitation is available to you. Always talk with your provider before beginning a new exercise routine. 

• Meet weight requirements. Studies demonstrate that outcomes are better when patients are at an ideal weight. All transplant centers have a minimum and maximum body mass index (BMI) for transplant. Maximum BMI criteria vary per center, but are usually 30-35. If you need to lose weight, focus on portion control and increasing your activity level. Ask your healthcare provider for referrals to a medical weight loss clinic or dietitian consultation. 
  

• Stay substance-free and tobacco-free. You must not use narcotics, THC, illicit drugs, or alcohol. You also must be tobacco-free (usually for at least six months) to begin a transplant evaluation. This includes nicotine replacement therapies like patches, gum, and vaping. The transplant team may test your blood at any time during the evaluation process. 
  

• Have a strong support system. Most centers require patients to identify two to three caregivers who can provide combined continual support during the pre- and post-transplant period. Caregivers may be family members, friends, and neighbors, as long as they can drive and are willing to learn to help care for a transplant patient. 
  

A Lung Allocation Score (LAS) is given to each patient who is added to the waiting list. The LAS directs donated organs to the people who will most benefit from a transplant. This calculation tries to predict the likelihood of survival in the next year without a lung transplant, and the likelihood of survival one year following lung transplantation. Some of the factors used in calculating the score are your age, oxygen requirement, pulmonary function test results, distance walked in six minutes, and type of lung disease you have. If some of these factors change while you’re on the waiting list, your transplant team will update your LAS.

When patients are placed on the waiting list, they’re registered in a centralized, national computer network that links all donors and transplant candidates. When donor organs are identified, the computer matching program immediately generates a list of potential recipients ranked according to objective criteria like blood type, medical urgency, time on the waiting list, and distance between donor and recipient. Other factors that are considered include donor height and antibodies, which could influence organ compatibility. Ethnicity, gender, religion, and financial status are not part of the computer matching system. Once the transplant surgeon for a matched recipient approves the lung, it’s transported to the recipient’s hospital at the same time the patient is being prepared for surgery.

The average time on the waiting list for patients with idiopathic pulmonary fibrosis (IPF) is three to six months, but an individual patient’s wait time is dependent on how advanced the disease is at the time of listing. It’s not possible to predict how long a patient will wait before a compatible lung becomes available. Some patients wait a few days; other times, the wait is many years, depending on the LAS. It may take longer to find a suitable match if:

• your blood type is less common
• you are very tall or very short
• you have high levels of antibodies against tissues received from others (due to a history of pregnancy, blood transfusions, or prior transplantation)
  

Lungs must be transplanted soon after donation, so timing is critical. Because you may receive the call at any time day or night, you and your support person must be ready at a moment’s notice to leave for your transplant center.

After the surgery, you’ll be cared for in the intensive care unit (ICU). Once you’ve left the hospital, your early recovery process continues at home. You should have at least two caregivers available so that someone can be with you 24 hours a day for the first several months after surgery.

In the early stages of recuperation, you should carefully avoid crowds and anyone who is sick. Your transplant team may also ask you to wear a mask when you leave the house. It’s best to restrict visitors to your home while you’re recovering. Frequent hand washing is an important way to prevent the spread of infection.

The two major issues facing transplant patients after surgery are rejection and infection. Because your risk of rejection or infection is highest in the first few months after surgery, you’ll need to remain close to your transplant center for a period of time defined by your transplant team-often two to three months.

You’ll need a lot of help as you recover from surgery. Although patients are encouraged to take on as much care for themselves as is appropriate, your caregivers are there to support you.

You can read about recovering from lung transplant surgery in Life After Lung Transplant.