Lung disease is characterized by the inability to breathe — that most basic of all human biological functions. People with lung disease are likely to experience shortness of breath, chronic cough and exhaustion. If the condition is severe and untreated, the patient eventually will die.
Lung transplantation for patients with severe diseases of the lung — such as emphysema, cystic fibrosis, pulmonary fibrosis, sarcoidosis and pulmonary hypertension — is considered only after all other treatments have failed. In some cases, congenital heart disease may cause advanced lung disease, requiring repair of these heart defects at the time of lung transplantation.
For a lung transplant to happen, two things must occur. First, the patient must be eligible for the transplant. Second, a suitable donor organ must be available.
At UCSF Medical Center, the Lung Transplant Program has performed more than 340 transplants, mostly bi-lateral, since the program began in 1991. The program is recognized for accepting patients with challenging, complex conditions, often patients who are turned away at other medical centers. Despite the difficult health issues, the survival rate for patients at UCSF is higher than the national average, according to data compiled by the Scientific Registry of Transplant Recipients.
In 2012, the UCSF program received a silver award from the U.S. Department of Health and Human Services, the highest award given to a lung transplant program, for excellent outcomes for adults over a 2.5-year period from January 2009 to June 2011. Lung transplant patients at UCSF had a one-year survival rate of 93.6, considerably higher than the 84.3 "expected" survival rate.
The high survival rate is particularly significant because of the complex conditions and high risk factors of the patients UCSF treats. UCSF is currently the leading medical center in the West based on these lung transplant outcomes and one of only three lung transplant programs in the country to have higher than expected one-year survival rates after transplant, according to data gathered by the national Scientific Registry of Transplant Recipients.
Patients must meet a broad range of physical and psychosocial criteria to become eligible for transplantation. A social evaluation determines if transplant candidates have the psychological stability, motivation and personal support to meet the challenges of transplantation. Then the patient and family meet with the team of experts who will be with them throughout the transplant process.
Each patient's team includes a transplant lung specialist called a pulmonologist, transplant surgeon, transplant nurse coordinator, transplant social worker, psychologist and physical therapist.
You can be called into the hospital for the transplant at any time. When the call comes, you will proceed to the Intensive Critical Care Unit (ICC) to prepare for surgery. Then you will be transferred to the operating room.
The surgery takes from six to 10 hours, depending on medical conditions. After surgery, you will go back to the ICC. From there, your are transferred to the cardiothoracic nursing unit, depending on your condition. The expected length of stay for an uncomplicated lung transplant is eight to 21 days.
If you are having a single lung transplant, the incision will be made on your side, either right or left, about six inches below your armpit. Your old lung will be removed through this opening and the new lung will be implanted. In the case of a double lung transplant, the incision will run across the lower part of your chest. The lung, whether single or double, is connected to the pulmonary artery, pulmonary veins and the main stem bronchus or airway. The incisions will be uncomfortable and will take several weeks to heal.
Once your surgery has been completed and the lung transplant is a technical success, the issue of successfully living with a transplant becomes quite involved. The two major issues are rejection and infection.
Lung transplant recipients undergo specialized rehabilitation programs. The transplant team follows patients throughout this process -- and for the rest of their lives. Patients are seen as needed in the outpatient clinic. A transplant expert is available 24 hours a day, seven days a week for questions or consultation.
Reviewed by health care specialists at UCSF Medical Center.