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Simply put, the lung transplant is for people who have end stage lung disease, where people don’t think that patient’s going to be alive in a year, that there are no medical choices anymore that will work. There are no mechanical choices and really they are left with replacement of the organ. And that’s a spectrum of diseases that include emphysema, pulmonary fibrosis, cystic fibrosis. It can be a variety of diseases, but at the end of the day, the patient has lungs that will not sustain them any longer.
A patient who is a good candidate for lung transplant has isolated failure of their lungs, and everything else is working okay. Now, people who have difficulties with their lungs over a long time may have problems with their heart, they may have problems with their kidneys. We’ll analyze all those things. What we don’t want to have happen is have a lung transplant that is successful – the lungs are working – but the rest of the body has failed. And that’s the process that’s very important when we evaluate that. So once we figure out the medical parts of things then we have to figure out the social parts of things. So, a successful lung transplant recipient is one that has excellent social support and that is both with people who will be there for you after the transplant as well as the resources financially and otherwise to get the transplant, come to the appointments, be vigilant for problems. All these things are also part of the evaluation process.
Can a patient with lung cancer get a lung transplant? The quick answer is no, however there is a specific type of lung cancer called bronchoalveolar cell carcinoma that we do offer lung transplantation in very select cases.
So the average age of transplant here at Johns Hopkins and nationally is in the 40s, however what we have seen over the last five to ten years is a dramatic increase in older patients getting lung transplants. Five years ago, we had a cut-off of about age sixty / sixty five for a lung transplant, but that is no longer the case. We’ve offered transplant to people in their seventies, and although their risks are higher, we’ve had terrific success in this age group. We are very careful about selecting patients who are older, but with proper selection, they can have a successful lung transplant.