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:
- end-stage lung disease
- bronchopulmonary dysplasia or chronic lung disease
- pulmonary hypertension
- heart disease or heart defects affecting the lungs
- pulmonary fibrosis
- cystic fibrosis
- alpha-1-antitrypsin deficiency
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.
Getting to 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.
- Smoking: You cannot be evaluated for lung transplant if you have smoked or used nicotine in the last 6 months.
- Age: You can be evaluated for transplant until age 75 at The Johns Hopkins Hospital.
- BMI: If you have a body mass index (BMI) greater than 30, you may be asked to lose weight prior to transplant.
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.
Most of your testing will be done at Johns Hopkins Hospital over a four day period.
Testing will be personalized to your health but may include:
- Blood work and urine testing
- Chest x-ray
- CT Scan
- V/Q Scan
- Swallowing tests
- Bone density testing
- PFTs and other tests in pulmonary lab
- Heart catheterization
- Mammogram (females over 40) Pap smear (females)
- Colonoscopy (if older than 50)
Consultations may include:
- Transplant Pulmonologist
- Transplant Surgeon
- Pre-Transplant Nurse Coordinator
- Social Worker
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.
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.
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.
Referring Guidelines for Lung Transplantation (Part 1)
Dr. Pali Shah talks about the guidelines for being referred for lung transplantation at the Johns Hopkins Comprehensive Transplant Center.
Lung Transplantation: Evaluation Process (part 2)
Learn more about the evaluation process from referral to becoming listed for lung transplantation with lung transplant coordinator, Gina Pace, R.N., B.S.N.
Lung Donor Transplantation: Donor Selection
Dr. Errol Bush talks about the donor selection criteria for lung transplant recipients.
Lung Transplantation: Hospital Course
Dr. Errol Bush walks through the process of the lung transplant procedure from admission to recovery.
Outcomes of Lung Transplantation
Lung transplantation at Johns Hopkins has a high success rate. Learn more about lung transplant outcomes from Dr. Pali Shah.
Lung Transplant Patient Guide Life Post Transplant
These downloadable PDFs are resources designed to help you learn about the new responsibilities and changes you will experience, following lung transplantation.