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Comprehensive Transplant Center

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Frequently Asked Questions

Why would I need a lung transplant?

 lungs

A lung transplant is a therapy for late-stage lung disease, when the patient’s lungs cannot sustain themselves. There are several situations in which a lung transplant may be considered. These include, but are not limited to:

In general, patients with lung cancer are not eligible for transplants. However, this depends on the type of lung cancer. Some patients may require a heart-lung transplant. You are encouraged to speak with your doctor or a member of our transplant team to explore your options.

Errol Bush, M.D., surgical director of the Johns Hopkins Advanced Lung Disease and Lung Transplant Program, answers some of the most frequently asked questions about lung and heart-lung transplants.

  

Lung Transplant

Am I eligible for a lung transplant?

The lung transplant team will conduct a comprehensive evaluation to determine whether you are eligible for a transplant. You will work with a transplant nurse coordinator and the lung transplant team, which includes surgeons, a social worker, a psychologist, a nutritionist, rehabilitation specialists and others.

Once you have completed your evaluation, your health status and history will be presented to the transplant committee. Good candidates usually have an excellent support system already in place at home. Many of the team members you meet during your evaluation are on the committee. These experts will make the final decision on whether transplantation is a good option for you.

The evaluation time takes approximately one to two months.

How long will I wait for new lungs?

In November 2017, a significant change was made to the organ allocation policy. Donor lungs are allocated based on the Lung Allocation Score (LAS), which ranges from 0 (less ill) to 100 (gravely ill). Previously, when an organ became available, the first offering would be made to the patient with the highest LAS in the local area. With the new policy, the first offering of the organ is now made to patients within a 250-mile radius of the donor hospital.

After being approved for transplant, patients are placed on the United Network for Organ Sharing (UNOS) list, which contains all individuals in the country who are waiting for an organ transplant. The wait time depends on a number of factors, including blood type, immunologic match, body size and the patient’s LAS score, which will be updated on a regular schedule and can be reassessed at any point if your clinical status changes. It is therefore important that the Johns Hopkins lung transplant team remain in close contact with you while you wait for your transplant. At the Johns Hopkins Comprehensive Transplant Center, the median wait time for a lung transplant is three months.

What is the average age of lung transplant patients?

The average patient getting a lung transplant is in his or her 50s. However, over the last five to 10 years there has been a dramatic increase in older patients getting lung transplants. Five years ago, the approximate age limit was between 60 to 65 years old, but that is no longer the case. Transplants have been offered to people in their 70s, and although the risks are higher, through proper selection, terrific success has occurred within this age group.

What is the surgery like?

Because a lung donated for transplant is only viable for a few hours without transplantation, you can be called into the hospital for surgery at any time. Prior to surgery, you will be asked to review and sign an informed consent form. During surgery, you may be connected to a heart-lung machine to maintain blood flow and oxygen; however, this is not necessary for all patients. An incision is made across the chest, so that the heart and lungs are exposed, enabling us to remove and replace one or both lungs. After the lung transplant surgery, the patient goes to the intensive care unit and later moves to the transplant unit. The average hospital stay after lung transplant is 14 days.

What quality of life can a patient expect after a lung transplant?

The goal of lung transplantation is to restore a person’s quality of life. We know from surveys that over 90 percent of patients after lung transplant will have few or no physical activity limitations. However, some people can have difficulties after lung transplant. Complications from surgery or anti-rejection medication, and improper lung function, can affect quality of life, but the vast majority of patients show major improvement.

 

Heart-Lung Transplant

Transplantation of the heart and lungs may be the only viable option for patients who have end-stage diseases of both the heart and lungs. Though uncommon, heart-lung transplantation may be required in cases of complex congenital heart disease, pulmonary hypertension and cystic fibrosis.

Can you describe the heart-lung transplant program?

Heart-lung transplantation has a long history at Johns Hopkins, with the first one performed in 1983. There was great interest in this procedure through the 1990s, but it has decreased because we are now able to provide lung transplants to many patients while medically managing their heart problems, and vice versa.

At Johns Hopkins, one to two heart-lung transplants are performed per year and there are about 15 to 30 done in the U.S. annually. The difficulty with a heart-lung transplant is the limited amount of available organs.

What is the surgery like?

The surgery is very similar to a lung transplant with respect to the incisions that we use and the possible use of a heart-lung machine. We remove both the heart and the lungs, place the new organs and then reconnect the airways, the connection tube to the rest of the body — the aorta — and the blood comes back to the heart. Sometimes removing the heart and lungs as a block can be very difficult if a patient has had previous surgeries, but the goals are very straightforward.

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