Heart-lung transplant - How a heart-lung transplant is performed

If a heart-lung transplant is thought to be a potential treatment for you, it is likely that you will be invited to your local hospital for an initial assessment.

The purpose of the assessment is to check whether you are a suitable candidate for a heart-lung transplant. Read more about who can have a heart-lung transplant.

Following an initial assessment, it is likely you will be invited to your nearest transplant centre for a more in-depth assessment if you are thought to be a suitable candidate.

Further assessment

The purpose of a further assessment is to build up a more detailed picture of your current state of health and to check whether there are any underlying problems that could affect your suitability for having a transplant. In addition, it is designed for you to have the chance to hear details about the possible outcomes of a transplant.

Before visiting the transplant centre, you may find it useful to write a list of questions that you would like to ask the transplant team.

As part of your assessment, you may have some of the tests described below:

• blood tests and urine tests to check for viral or bacterial infections and to assess the health of organs, such as your liver
• chest X-rays
• blood pressure tests
• a lung function test, which uses a machine called a pulse oximeter to measure the amount of oxygen in your blood
• computerised tomography (CT) scans and magnetic resonance imaging (MRI) scans, which can be used to check the health of certain organs, such as your lungs
• an electrocardiogram (ECG), which is a test that can measure the electrical activity of your heart

The whole assessment process usually takes between two to four days to complete. If your child is being assessed, the transplant centre will be able to arrange accommodation for you if you need it.

The final decision about whether you or your child is suitable for a heart-lung transplant is not made by one person. An agreement is reached on each candidate by a number of members of the team during a formal meeting.

There are three possible outcomes from this assessment period. The team may:

• think you will benefit from a transplant and offer you the opportunity to go on the transplant list
• request further investigations or certain targets to be met before you are offered a place on the transplant list
• not offer you a place on the transplant list if they feel there would be little benefit from a transplant

If it is decided that you or your child are not suitable for a heart-lung transplant, you will have the opportunity to discuss the treatment options that are suitable for you.

Once the decision has been made, you will have the opportunity to speak in person with a member of the transplant team.

Waiting for a suitable donor

It is impossible to say how long it will take for a suitable donor to be found. It may be several months or even years before a donated heart and lungs of the right size and blood group becomes available. The waiting times for a heart-lung transplant are very long and many people's conditions can deteriorate while waiting.

While you are on the list, you will be seen every few months to monitor your condition.

Your transplant centre will be able to offer any support, guidance and information you need while you are waiting for a suitable donor to be found. They will be fully aware that for many people this can be both a frustrating and frightening experience.

In some cases, a planned transplant might not go ahead. This may be because your health deteriorates to such an extent that a transplant is no longer considered to be a safe or effective treatment. Unfortunately, dying before a donated heart and lungs becomes available is also a possibility.

You should discuss both possibilities with the staff at your transplant centre and, if necessary, with your friends, family and loved ones.

The transplant operation

After a donated set of heart and lungs becomes available, your transplant team will contact you to arrange for transport to take you to the transplant centre as quickly as possible.

You will be taken to the operating theatre and given a general anaesthetic. A piece of equipment known as a heart-lung bypass machine will be attached to your body using tubes that are inserted into your blood vessels. The machine pumps oxygen-rich blood around your body until the operation is complete.

A cut will be made in your chest to enable the surgeon to remove your heart and lungs. The donated set of heart and lungs will be put in place and reconnected to the surrounding blood vessels. The incision in your chest will then be stitched up and you will be transferred to an intensive care unit (ICU), where your recovery will be closely monitored.

Because of the complexity of the procedure, a heart-lung transplantation usually takes several hours to complete.