A heart-lung transplant is surgery for someone with life-threatening breathing and heart problems. Surgeons remove the damaged heart and lungs and replace them with a healthy heart and lungs from a person who has died. The person receiving the new heart and lungs (the recipient) is someone with a high chance of dying within one to two years without a transplant. The person providing the healthy heart and lungs (the donor) is someone who is brain dead, but still on life-support machinery.
Currently, surgeons perform about 100 heart-lung transplants each year in the United States. This number is small mostly because there is a shortage of suitable donors. The requirements for heart-lung donation are stricter than those for heart donation alone. Only 10 percent to 20 percent of people who are suitable heart donors also fit the criteria for donating both heart and lungs.
Heart-lung donors are usually younger than 50 years old, have no history of heart or lung problems and are free from infectious diseases. Donor and recipient should be about the same height and weight so that their lungs are about the same size. The donor's chest X-ray must be normal, and the donor's lungs must have normal elasticity (ability to expand). The blood types of the recipient and donor also must be a good match. At any time, about 200 patients are on the national waiting list to receive a heart-lung transplant. About 20 to 40 of these patients will die within 12 months because suitable organs will not be found. In most cases, potential donor organs are located through an organization called the United Network for Organ Sharing (UNOS).
A heart-lung transplant treats irreversible, life-threatening lung disease in someone who also has significant heart damage. Because other treatment options have failed, the person has a high risk of dying within the next 12 to 24 months, even with oxygen and medication. Currently in the United States, surgeons perform heart-lung transplants for the following reasons:
- Congenital problems affecting the heart and lungs, especially Eisenmenger's syndrome (37 percent of all U.S. heart-lung transplants in 1997)
- Primary pulmonary hypertension, an illness in which increased pressure in the lung's blood vessels affects blood flow and oxygen exchange (about 19 percent of all heart-lung transplants)
- Cystic fibrosis (about 2 percent of heart-lung transplants)
- Other causes (about 25 percent), including emphysema, sarcoidosis, eosinophilic granulomatosis (a disease in which blood cells cause inflammation and damage in the lungs and elsewhere), asbestosis, and idiopathic pulmonary fibrosis (a disease in which the lung becomes scarred and stiff for unknown reasons)
To get into a heart-lung transplantation program, you must meet certain requirements. Although these vary slightly from program to program, the typical heart-lung transplantation candidate usually fits the following profile:
- Is age 55 or younger, and likely to die within one to two years without a transplant
- Has no other potentially life-threatening medical problem that can disqualify a candidate include significant kidney disease, HIV, pneumonia or another active infection, cancer, a history of stroke or significant circulatory problems affecting the brain, or severe type 1 (insulin-dependent) diabetes.
- Is emotionally stable
- Is willing to follow a rigorous program of diet and exercise and take medication
- Is not taking high doses of steroid medication
- Has not had prior chest surgery. This factor is controversial.
You will have a thorough evaluation, including a physical exam, chest X-rays, scans of your heart and lungs, tests of how well your lungs are functioning, cardiac catheterization and heart and lung biopsies. These tests confirm that you have life-threatening heart-lung problems that cannot be cured medically. Blood tests will be done to evaluate your kidney function, check for anemia and other blood problems and rule out viral illnesses such as HIV, hepatitis, herpes simplex virus and cytomegalovirus. Blood also is drawn for blood and tissue typing, which are used to find a donor match.
An intravenous (IV) line is inserted into a vein in your arm to deliver fluids and medications, and you receive general anesthesia. Your surgeon inspects the donor heart and lungs to confirm that they look healthy and are suitable for transplantation. The surgeon then cuts a clamshell-shaped incision in your chest. A heart-lung machine pumps your blood during surgery. The surgical team removes your failing heart and lungs. The donor heart and lungs are positioned in your chest and sewn in place.
Your new lungs are inflated gently. Your new heart and lungs were cooled to preserve them before transplantation. As it warms up to room temperature, your new heart might begin to beat on its own. If not, the surgeon triggers your heart to start beating with an electric shock. Once it is clear that your new lungs are functioning well and all potential sources of bleeding are controlled, you are disconnected from the heart-lung machine. The team closes your chest, and you are taken to the cardiac surgical intensive care unit.
After several days in the intensive care unit, you will be moved to a private room. Your total hospital stay will be about two weeks.
Before you leave the hospital, you doctor will give you prescriptions for several medications to prevent infections and reduce the risk that your body will reject your new organs. Your doctor will give you a schedule for follow-up visits. If you have any questions, concerns or unexpected symptoms after your transplant, contact the transplant team any hour of the day or night.
About 64 percent of all heart-lung transplant patients survive for 3 years after surgery. During the first two weeks after transplantation, some patients have an episode of organ rejection. This doesn't happen often, and it can be treated with corticosteroid medication. As with any surgery, there is also risk of infection and bleeding. The donor organs also may malfunction. In 30 percent to 50 percent of patients, a form of chronic rejection (called bronchiolitis obliterans) can attack the new lungs, causing breathlessness that usually cannot be treated.
After you leave the hospital, call your doctor immediately if:
- You develop chest pain, shortness of breath, dizziness or an irregular heartbeat.
- You have a fever.
- Your incision becomes red, swollen and painful, or it oozes blood.
United Network for Organ Sharing (UNOS)
P.O. Box 2484
Richmond, VA 23218
National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105