Heart-lung transplant

A heart-lung transplant is a major and rarely performed surgical procedure.

During a heart-lung transplant, a person's diseased heart and lungs are replaced with the heart and lungs of a recently deceased donor. As with any transplant there are risks, but the procedure aims to extend or improve quality of life in suitable candidates.

When is a heart-lung transplant needed?

A heart-lung transplant is the only treatment available for people who have combined heart and lung failure. It is a treatment that carries high risks but can offer benefits. For this reason it is only recommended when all other treatment options have failed.

In a healthy person, the heart and lungs work closely together. This means a problem in the lungs can damage the heart, or vice versa. If the damage is severe in both organs, replacing the heart or lungs alone may not be possible.

The conditions that most often require a heart-lung transplant are:

• adult congenital heart disease (ACHD) – where an adult has one or more birth defects that affect their heart
• pulmonary hypertension – where high blood pressure develops inside the blood vessels of the lungs, which can damage both the lungs and the heart

Occasionally, a heart-lung transplant may be used to treat cystic fibrosis, a condition where the lungs and digestive system become clogged up with sticky mucus.

How common are heart-lung transplants?

Heart-lung transplants are rarely carried out, either in the UK or the rest of the world. For example, three heart-lung transplants were carried out in the UK between April 2012 and March 2013.

The main reason for this is the shortage of suitable organs available for donation and the priority given to heart transplants.

Limitations on organ availability 

It is a complicated process to obtain a suitable organ and many things need to be correct before a transplant can be performed. Organs are initially matched based on blood group and size.

The heart and lungs are very delicate organs and the process of donation can make up to 70% of organs unusable.

The lung tissue rapidly deteriorates when it's removed from the body. A successful donation is usually only possible if the transplant is carried out within four to six hours of the lungs being removed from the donor. This usually means that a successful donation can only go ahead if the donor and recipient are in the same part of the country.

In addition, most donated hearts are from people who have been declared braindead. Although there is no activity in the brain, the heart can continue to beat spontaneously for many hours provided a ventilator is used to keep oxygen going into the bloodstream.

However, the prolonged use of a ventilator can damage the lungs, making them unsuitable for transplantation.

These factors mean there is a very low number of organs suitable for heart and lung transplants.

Read more about the transplant process.

Risks

A heart-lung transplant is a major procedure that carries a high risk of complications, some of which can be fatal.

This means the procedure is usually only carried out when all other treatment options have been exhausted and there is evidence to suggest that the potential benefits will outweigh the risks.

Read more about who can have a heart-lung transplant.

The main risks following a heart-lung transplant are your body rejecting the donated organs and immunosuppressant medication making you more vulnerable to infection.

Read more about the risks of having a heart-lung transplant.

Results

The outcomes of heart-lung transplants have improved significantly since the operation was first carried out in 1983. This is mainly because of the introduction of immunosuppressants, which help prevent the immune system rejecting donated organs.

In the UK, on average 78% of heart and lung transplants are still functioning well a year after surgery.

However, it is important to realise that survival rates are a guide and cannot predict outcomes for each person. There are many factors that could influence your own predicted survival. One of these factors is your age, as the results are poorer in older people.

Your transplant team will be able to provide more detailed information for you.

Help and support

Finding out that you need to have a transplant, waiting for suitable donor organs to become available and actually having the transplant can be emotionally demanding for both you and your family. Most transplant teams are able to offer counselling for this.

Alternatively, your GP should be able to refer you to a counsellor and provide you with information and advice about joining a support group in your area.

There are a number of support groups, charities and other organisations that offer support and advice. These include: