Lung Transplantation 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
  • During a lung transplant, diseased lungs are replaced with healthy ones gifted from a deceased organ donor.
  • 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.

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 2018 International Society for Heart and Lung Transplantation Registry report, the median survival for adults has improved from 5.5 years for those transplanted between 1990 and 1998 to 9.5 years for those transplanted between 1999 and 2016. This means that half of individuals transplanted between 1999 and 2016 were alive 9.5 years after transplant. Different factors potentially affect survival in children with CF for whom the median survival was 5.4 years for those who received transplants between 1999 and 20161

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:

  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
  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
  3. Getting evaluated -- consulting with the transplant team and having tests done to assess your ability to successfully undergo transplant surgery
  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
  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 UNOS waiting list and manage your health so you have the best chance for a good recovery from surgery
  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
  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, when donor lungs are available, those people who are at the highest risk of dying while they are on the lung transplant waiting list are considered first.

Waitlist urgency and transplant benefit are represented by a number called the Lung Allocation Score (LAS). The LAS is a number, ranging from 0 to 100. It is the result of a calculation that takes into account a person's age, body mass index (BMI), and certain medical test results. A higher LAS represents a more urgent need for those on a waiting list for a transplant. More information on how the LAS is calculated is available from the Organ Procurement and Transplantation Network (OPTN).

Everyone on the waiting list who is 12 years of age or older has an LAS to determine his or her place on the list. The LAS is not used for anyone younger than age 12. Instead, children in this age range are assigned a priority level based on their medical condition. Those with an urgent need for new lungs are categorized as Priority 1; all others are categorized as Priority 2.

According to the Cystic Fibrosis Foundation's Patient Registry for 2017, there were 1,548 people with CF who had received a transplant, including 250 people who reported to have received a lung transplant in 2017. The majority of 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, Cherikh WS, Chambers DC, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-fifth Adult Heart Transplantation Report-2018; Focus Theme: Multiorgan Transplantation. J Heart Lung Transplant. 2018 Oct;37(10):1155-1168. doi: 10.1016/j.healun.2018.07.022. Epub 2018 Aug 10.

2. Lung Transplant: Glossary of Terms

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Lung Transplantation
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