Determining if you are a candidate for lung transplant requires a comprehensive evaluation, beginning with a medical record review. If eligible, you would then need a variety of tests, including breathing tests, a CT scan, and a thorough evaluation by a pulmonologist (lung doctor) to determine whether any other treatments can be considered before lung transplantation. If you continue to be considered a candidate for transplantation, you will be scheduled to attend a transplant education class, have blood drawn, and meet with a social worker, transplant coordinator, and thoracic surgeon at a separate half-day appointment.

The next step is to schedule a heart catheterization, echocardiogram, and any other needed tests. Once all tests are completed, a multidisciplinary committee, which includes surgeons, pulmonologists, radiologists, nurses, nutritionists, and social workers, discusses possible wait-listing. If approved, you are placed on the lung transplant waiting list as a single or double lung candidate. A lung allocation score to prioritize the need for transplant is assigned to you. This score reflects both the seriousness of your medical condition before transplant and the likelihood of success after transplant. For more information on organ allocation policies, please visit United Network for Organ Sharing (UNOS)

Our dedicated transplant coordinators are the first contact for patients. You will be assigned a coordinator who is your point person for anything regarding your care, prior to transplantation. Their responsibilities include answering questions, completing everything needed for you to be listed, ensuring all periodic testing is scheduled, and alerting your medical team if you are having treatment for any other health issue. The transplant coordinator also serves as your liaison to the doctors.

One of our greatest priorities is to provide education and support to you before and after transplant. We provide a personal education class, an educational booklet with a DVD, as well as online Patient Education Videos. Our social workers are an integral part of our team, providing psychosocial support and organization of our lung transplant support group. This important peer group meets monthly and holds an annual summer picnic and holiday party for patients and their families.

Once you’ve been wait-listed, our team will see you quarterly to ensure that you are as healthy as possible for your transplant. This care is individualized to your specific needs and includes testing as needed, providing treatment for any health issues, and communicating with your primary care physician and local pulmonologist. Physical fitness is mandatory while waiting for a lung transplant. We require that you are as strong as possible so that you can recover quickly after the procedure. Therefore, you must enroll in a pulmonary exercise program to stay in shape. We also offer a Pulmonary Rehabilitation Program. Your lung allocation score is updated every quarter.

There is a chance that you won't be ready to be wait-listed. You may be too well to be listed for a transplant yet, not interested after learning about the procedure, not healthy enough to be a good transplant candidate, or have a disease that we can comprehensively treat – potentially delaying or eliminating the need for transplant.

Many patients are referred to us by their local primary physician or pulmonologist through U-M Health. We treat a full scope of conditions that can result in end-stage lung disease, including:

• Pulmonary fibrosis
• Cystic fibrosis
• Chronic obstructive pulmonary disease (COPD) and emphysema
• Pulmonary hypertension
• Sarcoidosis

Other options to delay lung transplant and/or prolong life while waiting for a donor lung include:

• A variety of medications, which is the most common form of therapy
• Supplemental oxygen therapy
• Lung volume reduction surgery (LVRS), which improves breathing by removing a portion of damaged lung tissue to help the remaining lung work more efficiently. This option is available only to a small portion of patients with emphysema
• Extracorporeal Membrane Oxygenation (ECMO), pioneered by Dr. Robert Bartlett, is a sophisticated technology that’s not widely available. A modified version of a heart-lung bypass machine, ECMO puts oxygen into the blood using an artificial lung located outside the body. Ambulatory ECMO is used as a bridge to lung transplant, keeping patients alive while they wait for a donor lung to become available. ECMO may also be utilized immediately following transplant until your donor lung(s) is/are working properly.
• Opportunities for novel therapies through clinical trials

When a donor lung becomes available, you will come to the Cardiovascular Center Intensive Care Unit to have monitoring lines placed. A ventilator tube is placed in the operating room. Your lung is removed, and the new donor lung is placed and connected. A single lung transplant takes about four hours, while a double lung transplant takes about six hours. Following surgery, you will stay in the Intensive Care Unit for about three days, with total time in the hospital approximately 10-14 days. While in the hospital, you will receive physical therapy, along with education, including how to properly take the anti-rejection medications, which are critical to the success of the transplant. The first follow-up appointment takes place three weeks after you are discharged from the hospital.

You will require lifelong follow-up at our lung transplant center. Follow-up appointments include pulmonary function testing, lab monitoring, and lung imaging to determine if there is any evidence of lung rejection or infection. Bronchoscopy is a procedure that requires the insertion of a lighted fiber optic tube into your lungs through your nose or mouth. This is done to evaluate your new lungs by obtaining samples of secretions and lung tissue to ensure you do not have an infection or are not rejecting your new lung(s). We frequently also adjust your medications to prevent lung rejection. Soon after receiving a lung transplant, you will be required to participate in the Pulmonary Rehabilitation Program.

Pre-Transplant Education (1:19:48): A comprehensive course for lung transplant patients and their families outlining the lung transplant journey from evaluation and wait listing to post-transplant and beyond.

Lung Transplant Social Work (7:27): An introduction to our transplant social workers and the services and support they offer both pre- and post-transplant.

Nutrition and Lung Transplantation: Two transplant nutritionists discuss important nutrition goals for before and after lung transplant

What Happens When You’re Called to the Hospital for Your Transplant (11:37): A transplant coordinator discusses how to prepare for the call for transplant and what to expect when you are admitted to the hospital.

Lung transplantation and swallowing: A speech pathologist will review swallowing issues related to lung transplantation.

Medications After Lung Transplantation (9:23): Our transplant pharmacists review important medications taken by patients post-transplant.

--What is Adherence? 
--What is Medication Adherence? 
--Traveling After Transplant 
--Prescription Refills for your Medications 

Frequently Asked Questions After Lung Transplant Surgery (8:28): Transplant Center staff discuss what to expect after your hospitalization for lung transplantation.

Exercises to Do Before Lung Transplantation (5:51): A physical therapist describes and demonstrates the exercises a patient should do before their lung transplantation.

Precautions for Patients After Lung Transplant Surgery (5:19): A physical therapist discusses the precautions patient should take after lung transplant surgery. 

Exercises to Do After Lung Transplant Surgery (6:29): A physical therapist discusses and demonstrates the exercises a patient should do after their lung transplantation.

Breathing Exercises to Do After Lung Transplant Surgery (7:44): A physical therapist discusses and demonstrates the breathing exercises a patient should do after lung transplantation.

Hear from our post lung transplant patients and caregivers about going through the transplant process and learning to live with new lungs. 

• Meet Angela (3:57) 
• Meet Carol and Tom (10:10) 
• Meet Megan (10:44) 
• Meet Steve (4:21) 
• Meet Roy and Jan (10:28) 

If you are interested in speaking to a peer mentor, please reach out to your transplant social worker.