Lung Transplant Today

A lung transplant may be a treatment option when your diseased lungs can no longer support your body's needs.

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Summary
  • Lung transplantation is a surgical option for people with cystic fibrosis who have advanced lung disease.
  • Lung transplantation can extend and improve your quality of life, but it involves an extensive evaluation and dedication to living the lifestyle required to keep your new lungs healthy.
  • The decision to pursue a lung transplant also requires great commitment from your family and friends who are part of your social support system.

Lung transplantation is a surgical option for people with cystic fibrosis who have advanced lung disease. During the operation, diseased lungs are replaced with healthy ones gifted from a deceased organ donor.

Median survival for people with CF who have had a transplant has improved. According to the 2019 International Society for Heart and Lung Transplantation Registry report, the median survival for adults transplanted between 1992 and 2017 is 9.9 years. This means that half of individuals transplanted between 1992 and 2017 were alive 9.9 years after transplant.1

Lung transplantation can extend and improve your quality of life, but it involves an extensive evaluation and dedication to living the lifestyle required to keep your new lungs healthy.

The decision to pursue a lung transplant also requires great commitment from your family and friends who are part of your social support system. This is why knowing what to expect will help you and your loved ones plan ahead to determine if transplant is a treatment option for you.

Download this graphic to help you start a discussion about the lung transplant process with your family and care team.

Lung transplant, a multiphase process:

This is an illustration of a patient talking to their doctor.

Phase 1 
Talking about transplant early — discussing transplant before you need to be referred so you can learn, plan, and work on improving your chances for a successful transplant

This is an illustration of documentation with patient data.

Phase 2 
Being referred — visiting with the transplant team so they get to know you as a person, you learn about them as partners in your care, and what to expect during an evaluation, surgery, and recovery at their center

This is an illustration of a stethoscope.

Phase 3 
Getting evaluated — consulting with the transplant team and having tests done to assess your ability to successfully undergo transplant surgery

This is an illustration of a care team reviewing patient information.

Phase 4 
Having your case reviewed — the transplant committee will recommend that you either be listed, have additional tests, live as usual until your lungs get worse, work on your health or social support, or not pursue a transplant at their center, at which point your care team can help you get opinions from other transplant centers

This is an illustration of a calendar.

Phase 5 
Ready to be listed — if the team recommends that you be listed for a transplant, they will help you decide when to get on the United Network for Organ Sharing waiting list and manage your health so you have the best chance for a good recovery from surgery

This is an illustration of the outside of a hospital.

Phase 6 
Receiving new lungs — you may need to move closer to the transplant center so that once donor lungs are available, you’ll be able to come quickly to the hospital for surgery to replace your diseased lungs with healthy ones

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Phase 7 
Living with new lungs — keeping your new lungs healthy by meeting with your care teams, exercising, and managing a new care plan that includes medications to prevent rejection and infections, and reducing the risk of germs, including germs from others with CF


 

How Are Lungs Allocated?

There are more people who need new lungs than there are available donor lungs. So, to determine who gets new lungs and when, people who are on a waiting list to receive new lungs are given a score. Known as a Composite Allocation Score (CAS), this score is based on factors that are specific to each person and their circumstances. The score ranges from 0 to 100. The higher the score a person has, the sooner they may be offered donor lungs. Each person’s score is calculated based on the factors below.

Factor considered Maximum points
Candidate medical urgency: How urgent a candidate’s need for transplant is. 25
Likely survival: How likely a candidate is to survive five or more years after transplant. 25
Blood type match: If the donor and candidate have matching blood types. 5
Immune system matching (CPRA): If a candidate has pre-formed immune antibodies that may cause rejection of lungs from certain donors (panel reactive antibodies) and limit who they can receive lungs from.   5
Height match: If the candidate is a similar height as the donor. 5
Listed younger than 18: If the candidate is younger than 18 years old. 20
Prior living donor: If the candidate has donated an organ in the past. 5
Travel efficiency: How efficient it is to transport the donor organ to the candidate. 5
Proximity efficiency: How near a candidate is to the donor organ. 5
Total Possible Score 100

You can calculate your CAS on the Organ Procurement and Transplantation Network web site.

This new CAS went into effect in the United States on March 9, 2023, replacing the previous lung allocation score (LAS). Learn more about the CAS from the Organ Procurement and Transplantation Network (OPTN). 

According to the Cystic Fibrosis Foundation's Patient Registry for 2021, there were 1,645 people with CF who had received a transplant, including 54 people who reported to have received a lung transplant in 2021. According to the Scientific Registry of Transplant Recipients, 32 people with CF received a first time lung transplant in 2022. Most lung transplant recipients were age 30 and older. 
 

Where Do Donor Lungs Come From?

Healthy lungs become available when someone dies and has expressed their desire to gift their organs to those in need. If a person dies without letting their families know that they want to donate their organs, their family is not obligated to give doctors permission to donate their lungs.2

This will be a difficult and emotional time. The donor's family will have lost a loved one, and you will be receiving another chance at life. Many transplant recipients want to express their gratitude with the donor's family. However, you will not be allowed to contact the donor's family immediately but may be able to do so after some time has passed and the donor's family agrees to be contacted. Organ procurement organizations (OPOs) will help facilitate the process of connecting recipients to donor families, so you can contact your local OPO to learn more.

Hear Craig Giddens, whose spouse received a double-lung transplant, read a letter expressing his gratitude to the donor's family.

REFERENCES

1. Khush KK, Cherish WS, Chambers DC, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult heart transplantation report - 2019; focus theme: Donor and recipient size match. J. Heart Lung Transplant. 2019 Oct;38(10):1056-1066. doi: 10.1016/j.healun.2019.08.004. Epub 2019 Aug 10.
2. Lung Transplant: Glossary of Terms

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Lung Transplantation
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