Your Lung Transplant Evaluation
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, discuss 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).
The Transplant Coordinator – Your Partner in Care
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.
Supporting You and Your Family
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.
Your Medical Care While Waiting for Lung Transplant
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 the University of Michigan Dyspnea Clinic, which is specifically for people with end-stage lung disease.
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
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, a University of Michigan professor of Surgery, 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.
Once a Donor Organ Is Available
When a donor lung becomes available, you will come to the Cardiovascular Center (CVC) 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.
Post-Transplant Follow-up Care
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.