Lung Transplant Process
The purpose of this video is to give you information
about the process of having a lung transplant.
Transplantation is a team effort. We are your team and you are the most important member!
It is important that you share all of this information with your family and others supporting
you in this journey. You must have a dedicated support person to accompany you throughout
the entire process of having a lung transplant. This video will help you to understand the
process of having a transplant and the significant changes that are required to your lifestyle.
The transplant assessment process Your lung transplant journey starts with a
referral from your respirologist. If the referral is accepted, you will meet with a lung transplant
respirologist. At this appointment, you will learn if lung transplant might be a good treatment
option for you. After this appointment, the lung transplant respirologist will ask the
team to plan a transplant assessment. This process helps to determine if transplantation
is the right treatment for you and ensures that it is as safe as possible for you to
have a transplant. The assessment process will involve coming to the hospital to have
a number of tests, and meeting with key members of your team. Having a lung transplant is
a big decision. You need to understand the benefits, the risks, and our program requirements.
The assessment process will give you and our team the information to make an informed decision
about having a lung transplant.
Once your assessment is complete, the transplant team will meet to review your results. This
assessment process can take up to 8 weeks. Your transplant coordinator will call you
to discuss the results of your assessment. If a transplant is recommended, the choice
to proceed is up to you. We will support you whether you go forward with a transplant
or not.
Waiting on our list If you decide to have a lung transplant you
will meet with a lung transplant surgeon and your transplant coordinator to discuss your
surgery and to sign surgical consent forms. At this point you are officially placed on
the lung transplant waiting list.
The time that you wait for your lung transplant is unpredictable because you have to be matched
to a suitable donor. Our surgeons use several factors to match donors with patients on the
waiting list. Two of the most important factors are: Blood type and lung size
Because of this, there is no “TOP” spot on the waiting list.
While you are waiting for your lung transplant there are three main goals:
First, maintain your health and improve your strength. Our physiotherapy program will help
you achieve this goal. The physiotherapists will also work with the doctors to ensure
your oxygen needs are met. Second, identify and manage any new and existing
problems that may arise. We will partner with your local healthcare team to manage your
health. You and your support person will attend frequent appointments at our hospital.
Third, continuing to learn about life with a lung transplant through our support and
education groups and by speaking to your transplant team.
Your surgery:
Immediately before transplant, we will do a few last minute tests and you will receive
anti-rejection medications and antibiotics. There is a chance that the surgery will be
cancelled at the last moment as the team is assessing the donor lungs right up to the
moments before the surgery.
In the operating room, you will be given medication to keep you unconscious. Several tubes are
inserted into your body, including an endotracheal tube, which is a breathing tube that extends
from your mouth into the lungs, an intravenous line in your neck, a nasogastric or “NG”
tube that goes into your stomach through your nose, and a urinary catheter that drains urine
freely into a bag.
The surgery itself can take 6 or more hours depending on your condition and whether you
have a double or a single lung transplant. Some people need to have their lung or heart
function supported by machines before, during or after the surgery.
Your chest will be opened between the ribs in the front across the breast bone or at
the side. The diseased lungs will be removed and replaced with the donor lungs one at a
time. The new lung will be connected to the main bronchus, the pulmonary artery, and the
pulmonary vein. After the lung is connected, the surgeons will leave drainage tubes around
the lungs and heart and carefully close the layers of bone, muscle and skin.
After the surgery, you will be taken to the intensive care unit, or ICU. You will remain
there until you can breathe without the help of the ventilator, or breathing machine, and
until your condition is stable. In the ICU, you will be on a monitor that shows your heart
rate, blood pressure and other vital signs to the team at all times. The endotracheal
or “breathing” tube, intravenous, chest tubes, nasogastric tube and urinary catheter
will be removed as your condition improves.
If you still require the ventilator to breathe after about a week, you may need to have a
temporary tracheostomy tube inserted through your neck into your trachea. The tracheostomy
will make you feel more comfortable and help you to get strong enough to breathe without
the ventilator and will make it easier to clear mucus from your lungs. The staff will
be able to suction mucus from your lungs through the endotracheal or tracheostomy tubes. While
on the ventilator you will not be able to talk, but if you are awake enough, you will
be able to communicate by mouthing words, writing or using other devices.
Once you are well enough to leave the ICU, you will be moved to the acute care unit,
or ACU, and then to the regular care unit. Most people stay in hospital for about 10
days to a few weeks after receiving a lung transplant, while others may have a longer
stay.
You will be given anti-rejection and anti-infection medications to ensure that your lungs work
well. You will also receive medications for other conditions that you might have, such
as pain. Pain should improve over time and pain control is a priority because you must
participate in physiotherapy after the transplant to gain strength and avoid other complications.
You will be sitting in the chair and walking as soon as possible after the surgery with
the help of the physiotherapists and nurses.
The team will help to get you home or to a rehabilitation hospital as soon as it is safe.
The team includes doctors, pharmacists, dieticians, speech language pathologists, occupational
therapists, physiotherapists, nurses and social workers.
After discharge from the Hospital:
As you recover from your transplant, we will help you to learn how to monitor your own
health and to understand complications that may occur.
After transplant, you will have weekly clinic visits at the Ambulatory Transplant Clinic
for the first few months and then less frequent visits over time. It is mandatory that your
support person attends all your clinic visits. Before each clinic visit, you must have blood
work, a chest x-ray and a pulmonary function test. Bronchoscopies and CT scans of the chest
will also be done at longer intervals.
You will participate in an exercise program 3 times a week for the first 3 months after
your discharge. The Physiotherapy team will monitor your physical progress and develop
an exercise program with you. Ongoing exercise is recommended after completion of your supervised
program.
Rejection and Infection Two of the most common complications following
transplant are rejection of the lung and infections.
Rejection is common and can happen any time after your transplant. Rejection happens because
your immune system attacks your transplanted lungs. Your immune system sees your new lungs
as invading cells and can damage them. To prevent this, you will take anti-rejection
medications, also called immunosuppression medications. You will need to take these medications
every day for the rest of your life to protect your new lungs.
Despite taking anti-rejection medications, rejection can still occur. It is often reversible
as long as it detected and treated quickly. If rejection is detected your treatment plan
may include additional medications, adjusting your current medications and other treatments.
Unfortunately, immunosuppressive medications also decrease the body’s ability to fight
infection and infections of the lungs are very common.
Your weekly clinic visits will allow the transplant team to monitor for rejection and infection.
You will also need to: Perform home spirometry readings once daily
and keep a record of your readings. Learn the signs and symptoms of rejections
and infections and report any unusual symptoms to your transplant team right away.
The Transplant Program will continue to monitor your health, and will work closely with you
and your support person, your family doctor and your Respirologist for the rest of your
life. Your family doctor will continue to help you to maintain your general health and
well-being. You will be assigned a transplant nurse coordinator and physician who you and
your care providers can communicate with. Your team is there to help you, but it is
important that you play an active role in maintaining your health and keep them informed
about changes.