Lung Transplant and Heart-Lung Transplant Basics
Overview: Lung Transplantation is a surgery used to replace diseased lungs or heart with a healthy heart and lungs from a human donor. Types of surgery include: single-lung transplantation, double-lung transplantation, heart-lung transplantation.
Lung transplant operations have been performed since 1980 in the United States. The heart and lungs are usually donated from a human who has been declared brain-dead yet remains on life-support. Tissue matches are made to match a patient and donor to minimize the risk of the patient rejecting the transplanted lung or heart.
The patient is placed under general anesthesia and an incision is made through the breast bone (sternum). At the same time tubes re-route the blood to a special heart-lung bypass machine that keeps the blood oxygenated and circulating during the surgery. The patient's heart and/or lungs are removed and the donor heart and lungs are stitched into place.
Heart-lung transplant may be recommended for patients with severely diseased lungs such as primary pulmonary hypertension or a severely damaged heart which occurs in severe cases of pulmonary hypertension.
The lungs work to bring air in contact with blood so that oxygen can be introduced into the body and carbon dioxide removed. The lungs are two cone shaped, spongy organs inside the chest cavity. Lungs lie from the bottom of your chest to a point above the collar bone and they lie against your ribs. The back surface of each lung is curved to make room for the heart, esophagus, trachea, nerves and the blood vessels in the chest.
The breathing passages and lungs resemble an upside-down tree covered by two balloons. The trunk of the tree represents the windpipe or trachea. The windpipe carries air from the outside into your lungs.
The trachea divides into two main branches known as the left and right main stem bronchi. These main stem bronchi are the actual passages for air moving to and from each lung. The bronchi continue to divide into smaller tubes called bronchioles that eventually end in little air sacs called alveoli, which resemble a microscopic bunch of hollow grapes. It is at the level of the alveoli, the tiny air sac, where the oxygen you breathe in goes into the blood and the carbon dioxide that your body has produced is exhaled.
The left lung is partially divided into two lobes, the upper and lower. The right lung is divided into three lobes, the upper, middle and lower.
Having a single lung transplant means having an operation to remove one of your diseased lungs and replacing it with a new lung. Having a double lung transplant means having an operation to remove both of your diseased lungs. These lungs are are replaced with the healthy lungs from another human being. This new lung(s) will work to help you breathe by providing your body with oxygen and removing carbon dioxide just as your own lungs did when they were healthy. This new lung or lungs will come from a person who is an organ donor. This person has suffered and injury to the blood supply to the brain which results in "brain death". This person's lungs are normal and not affected by this injury.
Before the transplant the doctor matches donors with the people who are awaiting transplants. This matching is based primarily on the size of the donor and the blood type. The lungs from the donor are removed by a surgeon from the Transplant Team who brings the lungs to the Hospital. While this is happening the patient may be notified to come to the emergency room at the Hospital. The patient is then transferred to the operating room where an anesthesiologist will prepare them for surgery.
If you are having a single lung transplant, the incision will be made on your side, either right or left, about six inches below your underarm. A small section of the rib will be removed permanently to allow access to the surgical site. Your old lung will be removed through this opening and the new lung will be implanted.
In the case of a double lung transplant the incision will run across the lower part of your chest. One lung will be removed, and the new one implanted; then the second lung will be removed and the new one implanted.
The lung, whether single or double, is connected to the pulmonary artery, pulmonary veins, and the mainstem bronchus(airway). The incision or incisions are closed and a dressing is applied. The incisions will be uncomfortable and will take several weeks to heal.
A lung transplant generally prolongs the life of a patient who otherwise would die because of advanced stage PPH. A transplant is performed only in patients where there is a very good chance of success. According to the United Network for Organ Sharing (UNOS) the patient survival rates for all patients that had a lung transplant are 85% at one month, 69% at one year, and 51% at three years for patients transplanted between 1987 and 1992. Results since those years are likely to be much better.
The problems related to heart lung transplants are finding a donor, fighting the rejection effect, and the cost of the surgery.
Finding a donor for heart-lung transplant is difficult. The organs must come from a person who has been declared brain-dead but is still on life-support while the patient is still in healthy-enough condition to survive the surgery.
After the surgery the body may reject the organs. The body's immune system may consider the transplanted organs an invader and rejects the organs the same way it would fight an infection. To stop the body from reacting in this way, organ transplant patients are given anti-rejection (immunosuppression) drugs (such as cyclosporine and corticosteroids) that suppress the body's immune response and reduce the chance of rejection. Unfortunately these drugs also reduce the body's natural ability to fight off other dangerous infections.
A patient undergoing a lung transplant will often remain in the hospital for months, the full recovery period is about 6 months. Follow-ups along with blood tests and X-ray will be necessary for the remainder of the patients life.
The surgery is very expensive
Heart-lung transplant surgery may exceed $250,000. However the costs of any surgery varies significantly between surgeons, medical facilities, and regions of the United States. Patients who are younger, sicker, or need more extensive surgery will require more intensive and expensive treatment.
Surgery charges can be separated into five parts: 1) the surgeon's fee usually very expensive, 2) the anesthesiologist's fee $350 to $400 per hour, 3) the hospital charges $1,500 to $1,800 per day, which includes nursing care and the operating room, 4) the medications, and 5) additional charges.
Insurance coverage for surgery expenses depends on many factors and should be explored for each individual instance. This site offers PPH patients guidance about their legal options to help pay for treatment if insurance is inadequate or denied; or if the disease is related to the ingestion of diet drugs such as fen phen, phentermine or pondimin. More Info >>
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