>> As we begin it is important to talk about how lung transplantation differs
from other solid organ transplants.
The heart, liver and kidneys are all contained completely inside the body.
Lungs are large solid organs that while contained
in the chest are constantly exposed to the external environment.
Everything we inhale goes through the lungs.
These are like big filters.
There are a lot of cells within the lungs that protect us from getting infections.
You can inhale any type of virus, bacteria or fungi through the lungs as well.
After transplantation you will be on many medications that suppress your immune system
so your body can accept the new lungs and not reject them.
Because of the constant exposure to the external environment we have more problems
with infections and organ rejection with lung transplantation than with other organs.
That in combination with the fact that there are just not
that many donor lungs available has made identifying eligible transplant candidates
extremely important.
Consequently our medical transplant evaluation will probably be the most thorough exam you've
ever had.
Your medical evaluation will be performed by one of our transplant pulmonologists.
During this exam your pulmonologist assesses the extent of your lung disease
and your medical suitability for transplantation and discusses the significance
of transplantation including the risks and complications.
Your pulmonologist also manages transplant related medical needs prior to transplantation,
participates in care during the transplant hospital admission,
monitors immunosuppressive medications
and manages your medical care following lung transplantation after discharge.
To start this exam you will have a lot of blood drawn.
Many tests are run so your pulmonologist can get a picture of your overall health.
Your blood will also be tested for the presence of nicotine,
chronic substance use, alcohol and illicit drug use.
If you were a smoker you have to be smoke-free
for at least six months prior to your evaluation.
This includes any nicotine containing products such as gum or patches.
If you continue to smoke, you will not be a candidate for transplant.
Any evidence of chronic substance use, heavy alcohol use
or illicit drug use makes you ineligible for a transplant evaluation.
You must cease using these substances for at least six months prior to evaluation.
Your weight and nutritional status are also important factors
when we're evaluating you for transplant.
If you are too skinny you may be malnourished with all
of your calories going towards helping you breathe.
Underwent patients do not do well after transplant surgery.
On the other hand, obese patients tend not to do well after surgery either.
To frame this discussion about your weight, your pulmonologist will use the body mass index
and discuss the specifics with you.
You will be required to participate in an exercise program.
Lung transplantation is a big operation.
You need to be in the best physical shape possible to prepare for this surgery.
Exercise will help condition you for surgery.
You will also be asked to perform a six minute hall walk.
During this time you must be able to walk at least 450 feet.
As we have said before, lung transplantation is a big surgery.
You must be strong enough going into the surgery to be able to recover successfully.
If you are already in a wheelchair and cannot walk because of shortness of breath,
you may be too weak to be a candidate.
Other tests you will need include a cotinine test, chest x-ray,
24-hour pH probe and an arterial blood gas.
Since you'll be on corticosteroids after transplant you'll need a bone densitometry test.
Corticosteroids can break down your bones over time and we have to treat
that effectively to prevent any complications.
Certain tests like colonoscopy, mammograms, Pap smear and rectal
and prostate exams may be handled by your primary care physician.
Your regular physician is also instrumental in managing other maintenance issues
like immunizations for hepatitis A and B as well as testing for tuberculosis.
You will need to get medical clearance from your dentist as well.
Let's look at some reasons you may not be eligible for lung transplantation.
Many of the anti-rejection medicines we use actually speed up the growth of cancer cells.
If you have a history of cancer you must be cancer free
for at least five years before we will consider you for lung transplantation.
The only exception to the five year period is skin cancer.
Your blood will also be screened for any incurable viral infections
such as active hepatitis C or human immunodeficiency virus or HIV.
If you have either of these you cannot be a candidate in our program.
Some programs will transplant hepatitis C donor organs into someone who has hepatitis C,
but we do not do that in the lung program at the University of Michigan.
There are other conditions that may make you ineligible for lung transplant.
If you are chronically ventilator dependant, have active
or current antibiotic resistant infections, suffer from an incapacitating mental illness,
have systemic disorders such as connective tissue diseases, demyelization disorders
or are nursing home dependant we cannot consider you for transplantation.