Lung transplant - How to prepare for a lung transplant

If a lung transplant is thought to be an option for you, you will be referred for a transplant assessment.

Transplant assessment

You will need to stay in hospital for up to three days for a lung transplant assessment.

Tests are carried out to make sure your other major organs (such as your heart, kidneys and liver) will function properly after the transplant. These may include blood tests and any of the following investigations:

• chest X-ray
• echocardiogram, which checks how well your heart is pumping
• electrocardiogram (ECG), which records the electrical activity of your heart
• angiogram, an X-ray that takes pictures of the blood flow in the vessels of your lungs 

During the assessment, you will have the chance to meet members of the transplant team and ask questions. Your transplant team will include:

• surgeons
• anaesthetists
• intensive care specialists
• lung specialists
• specialists in infection
• a transplant nurse
• physiotherapists
• psychologists
• social workers
• a transplant co-ordinator

The transplant co-ordinator (your main point of contact) will talk to you and your family about what happens, and the risks involved in a lung transplant.

When the assessment is complete, it will be decided whether a lung transplant is suitable for you and if it is the best option.

It may be decided that:

• you should go on the active waiting list – which means you could be called for a transplant at any time
• a transplant is suitable for you, but your condition is not severe enough – you will be reviewed regularly and if your condition worsens, you will then be put on the active waiting list
• you need more investigations or treatment before a decision can be reached
• a transplant is not suitable for you – in this case, the assessment team will explain why and offer you other options, such as drug therapy or alternative surgery
• you need a second opinion from a different transplant centre

Why you might be unsuitable for a lung transplant

The supply of donor lungs is limited, which means there are more people who would benefit from a transplant than there are donor lungs.

This means people who are unlikely to have a successful transplant are not usually considered suitable for transplant.

You may be considered unsuitable if:

• you have not complied with previous advice or been reliable – for example you have not given up smoking, you have a poor history of taking prescribed medication or you have missed hospital appointments
• your other organs, such as your liver, heart or kidneys, do not function well and, therefore, may fail after the stresses of the transplant operation
• your lung disease is too advanced, so it is thought you would be too weak to survive surgery
• you have a recent history of cancer – there is a chance that the cancer could spread into the donated lungs; exceptions can be made for some types of skin cancer as these are unlikely to spread
• you are carrying an infection that would make the transplant too dangerous
• you have psychological and social problems that may affect whether you take post-transplant treatments; such as being addicted to drugs or having a serious mental health condition
• you are significantly underweight with a body mass index of less than 16 or overweight (obese) with a body mass index of 30 or above

Age also plays a part due to the effect it has on likely survival rates. There are no set rules and exceptions can always be made, but as a general rule:

• people over the age of 50 would not be considered suitable for a heart-lung transplant
• people over the age of 65 would not be considered suitable for a single or double lung transplant

The waiting list

Once you are on the active waiting list, the transplant centre may give you a pager so you can be contacted at short notice. 

The length of time you will have to wait will depend on your blood group, donor availability and how many other patients are on the list (and how urgent their cases are).

While you wait, you will be cared for by the doctor who referred you to the transplant centre. Your doctor will keep the transplant team updated with changes to your condition. Sometimes, another assessment is necessary to make sure you are still suitable for transplant.

Generally, your transplant team will be given relatively short notice of donor organs, so will have to move swiftly. When a suitable donor is found, you will normally be in hospital ready for your transplant within six to eight hours. If you live a long way from a transplant centre, you will be flown to the centre or taken by ambulance.

Getting the call

When a suitable donor lung is found, the transplant centre will contact you and ask you to go to the centre.

When you hear from the transplant centre:

• do not eat or drink anything
• take all current medicines with you
• take a bag of clothes and essentials for your stay in hospital

At the transplant centre, you will be reassessed quickly to make sure no new medical conditions have developed. At the same time, a second medical team will examine the donor lungs.

The procedure must be carried out as quickly as possible for the transplant to have the best chance of success.