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Stanford’s Center for Advanced Lung Disease is one of a few in the country providing specialty care for patients with cystic fibrosis, interstitial lung disease, emphysema, pulmonary hypertension, advanced cardiopulmonary diseases, and lung transplant. Since performing the first successful heart-lung transplant more than thirty years ago, our team of pulmonary experts continues to develop innovative strategies for the treatment of advanced lung disease.
Care and Treatment
Since January 1988–May 2011, there have been 22,279 lung transplants performed in the US.
In 2011, 1,770 lung transplants were performed nationwide.
There are currently over 1,700 people awaiting a lung transplant.
Where do transplanted organs come from?
The majority of lungs that are transplanted come from deceased organ donors. Organ donors are adults or children who have become critically ill and will not live as a result of their illness. If the donor is an adult, he/she may have agreed to be an organ donor before becoming ill. Parents or spouses can also agree to donate a relative's organs. Donors can come from any part of the United States. This type of transplant is called a cadaveric transplant.
The United Network for Organ Sharing (UNOS) is responsible for transplant organ distribution in the United States. UNOS oversees the allocation of many different types of transplants, including liver, kidney, pancreas, heart, lung, and cornea.
UNOS receives data from hospitals and medical centers throughout the country regarding adults and children who need organ transplants. The medical team that currently follows a patient is responsible for sending the data to UNOS, and updating them as a patient's condition changes.
Once UNOS receives the data from local hospitals, people waiting for a lung transplant are placed on a waiting list and given a "status" code.
When a donor lung becomes available, a computer searches all the people on the waiting list for a lung and sets aside those who are not good matches for the available lung. A new list is made from the remaining candidates.
The person at the top of the specialized list is considered for the transplant. If he/she is not a good candidate, for whatever reason, the next person is considered, and so forth. Some reasons that people lower on the list might be considered before a person at the top include the size of the donor organ and the geographic distance between the donor and the recipient.
How is a patient placed on the waiting list for a new lung?
An extensive evaluation must be completed before a patient can be placed on the transplant list. Testing includes:
Psychological and social evaluation of the patient and the family
Tests are done to gather information that will help ensure a patient receives a donor organ that is a good match. These tests include those to analyze the general health of the body, including the patient's heart, lung, and kidney function, the patient's nutritional status, and the presence of infection.
Blood tests will help improve the chances that the donor organ will not be rejected. These tests may include:
Patient's blood type: Each person has a specific blood type: type A+, A-, B+, B-, AB+, AB-, O+, or O-. When receiving a transfusion, the blood received must be a compatible type with the patient's own, or an allergic reaction will occur. The same allergic reaction will occur if the blood contained within a donor organ enters the patient's body during a transplant. Allergic reactions can be avoided by matching the blood types of the recipient and the donor.
Kidney, liver, and other vital organ function tests
Viral studies: These tests determine if the patient has antibodies to viruses that may increase the likelihood of rejecting the donor organ, such as cytomegalovirus (CMV).
The diagnostic tests that are performed are extensive, but necessary to understand the complete medical status of the patient. The following are some of the other tests that may be performed, although many of the tests are decided on an individual basis:
The transplant team will consider all information from interviews, the patient's medical history, physical examination, and diagnostic tests in determining whether the patient is a candidate for lung transplantation. After the evaluation and after the patient has been accepted to have a lung transplant, the patient will be placed on the United Network for Organ Sharing (UNOS) list.
How long will it take to get a new lung?
There is no definite answer to this question. It may take one to two years on the waiting list before a suitable donor lung is available. It may happen in as little as three months or up to two years before a suitable donor is available. Various support groups are also available to assist you during this waiting time.
How are we notified when a lung is available?
Each transplant team has their own specific guidelines regarding waiting on the transplant list and being notified when a donor organ is available. In most instances, you will be notified by phone or pager that an organ is available. Patients will be told to come to the hospital immediately so he or she can be prepared for the transplant.
Alicia Bland, who suffered from lung disease for three decades, got new lungs and “a second chance at life.”
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HOW TO REFER
Different programs in our clinic require different records and test results. Use the following checklists to determine what to send when making a referral. When you are ready to make a referral, fax a referral form with supporting documentation to 650-723-3106.
Heart-Lung and Lung Transplant Program
Patient Referral Form
Patient phone number, address, and Social Security Number
History and physical, clinic notes, or hospital discharge summary
Pulmonary function studies
Thoracic CT scan report (if performed)
Sputum cultures and sensitivities for patients with cystic fibrosis or bronchiectasis
Copy(s) of heart catheterization report(s) if performed
Adult Cystic Fibrosis Program
Patient Referral Form
History and physical notes, including clinic or office notes and current medications
Hospital discharge if in last two years
Recent PFT or spirometry
Recent Sputum cultures and sensitivities
Recent CT scan
Interstitial Lung Disease Program
Patient Referral Form
Most recent Pulmonary Function Tests (breathing tests)
CDs of recent high resolution CT scan of the chest, any other recent CT scans
Any lung biopsy reports, including slides
Recent lab work, including any serology testing done to identify autoimmune disease
Recent history, office visit, and physical notes from local pulmonologist or primary care provider
Current list of medications
Discharge summary from any recent hospitalizations
"Six Minute Walk" or other oxygen exercise testing