Lung Transplant: Before the Procedure

Before the Procedure

If you are going to receive a lung from an organ donor who has died (cadaver), you will be placed on a waiting list of the United Network for Organ Sharing (UNOS.) The average person waits around two years for a single lung transplant, and as long as three years for two lungs. People who are unable to wait that long may be considered for lung transplant from a living donor.

Because of the wide range of information necessary to determine eligibility for transplant, the evaluation process is carried out by a transplant team. The team includes a transplant surgeon, a transplant pulmonologist (physician specializing in the treatment of the lungs), one or more transplant nurses, a social worker, and a psychiatrist or psychologist. Additional team members may include a dietician, a chaplain, and/or an anesthesiologist.

Components of the transplant evaluation process include, but are not limited to, the following:

• Psychological and social evaluation: Psychological and social issues involved in organ transplantation, such as stress, financial issues, and support by family and/or significant others are assessed. These issues can significantly impact the outcome of a transplant.
• Blood tests: Blood tests are performed to help determine a good donor match and to help improve the chances that the donor organ will not be rejected.
• Diagnostic tests: Diagnostic tests may be performed to assess your lungs as well as your overall health status. These tests may include X-rays, ultrasound procedures, computed tomography (CT scan), pulmonary function tests, lung biopsy, and dental examinations. Women may receive a Pap test, gynecology evaluation, and a mammogram.
• Other preparations: Several immunizations will be given to decrease the chances of developing infections that can affect the transplanted lungs. In addition, lung transplant recipients who smoke must quit smoking and be nicotine-free for several months before being put on the transplant list.

The transplant team will consider all information from interviews, your medical history, physical examination, and diagnostic tests in determining your eligibility for lung transplantation.

Once you have been accepted as a transplant candidate, you will be placed on the United Network for Organ Sharing (UNOS) list. When a donor organ is available, lung recipients are selected based on blood type, geographic location (distance between donor and recipient), and lung allocation score. This score is based on medical urgency rather than length of time on the waiting list. You will be notified and told to come to the hospital immediately so you can be prepared for the transplant.

If you are to receive a lung from a living donor, the transplant may be performed at a planned time. The potential donor(s) must have a compatible blood type and be in good health. A psychological test will be conducted to ensure the donor is comfortable with the decision.

The following steps will precede the transplant:

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if something is not clear.
• For a planned living transplant, you should fast for eight hours before the operation, generally after midnight. In the case of a cadaver organ transplant, you should begin to fast once you are notified. that a lung has become available.
• You may receive a sedative prior to the procedure to help you relax.
• The area around the surgical site may be shaved.
• Based upon your medical condition, your physician may request other specific preparation.