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Lung Transplants: Your Questions Answered

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Posted by Kevin Carney, MSN, CRNP, CCTC

Widely recognized as one of the nation’s largest lung transplant programs, the Temple Lung Center has helped many people live longer, healthier lives — including those turned down for a lung transplant at other hospitals. 

I think about the wonderful people who have benefited from our program all the time.

Though lung transplant surgery is a lifesaving procedure, at the Temple Lung Center we realize that the entire process can feel overwhelming for potential transplant candidates. So it’s only natural that our patients have many questions. In this blog, I will answer some of the most common questions that we hear. 

Q. Who may need a lung transplant? 

Your doctor may recommend a lung transplant if you have advanced lung disease that continues to worsen despite other therapies. Lung diseases that may lead to lung transplant include:

  • Pulmonary fibrosis (PF), which is characterized by scarring of the millions of tiny air sacs — alveoli — in the lungs. When functioning normally, the alveoli absorb the oxygen we breathe, disperse it throughout the body’s tissues, pick up carbon dioxide from the blood, and release it when we exhale. Scarred alveoli cannot complete this process efficiently, causing a chronic oxygen deficit in the blood and shortness of breath. There are hundreds of potential causes of PF, and sometimes no specific cause can be identified. This is known as idiopathic pulmonary fibrosis, or IPF.
  • Hypersensitivity pneumonitis, a rare immune system disorder caused by inhaling mold, dust or other substances in the environment. The signs and symptoms of hypersensitivity pneumonitis include cough, shortness of breath, chronic bronchitis, chest pain, and extreme fatigue.
  • The autoimmune disease scleroderma — a hardening and tightening of the skin and organs, including the lungs.
  • Sarcoidosis, a disorder in which inflammatory cells attack the body, especially the lungs and lymph nodes.
  • Pulmonary hypertension, characterized by high blood pressure in the arteries that lead from the heart into the lungs.
  • Chronic obstructive pulmonary disease (COPD), which mainly includes emphysema or chronic bronchitis. 

A lung transplant allows many recipients to enjoy an improved quality of life. They usually no longer need oxygen therapy and can do many of the things they couldn’t do before, like dance, walk on the beach, and exercise. 

Q. How do I get on the lung transplant list? 

First, make an appointment with a pulmonologist to start the transplant evaluation process. At the Temple Lung Center, our specially trained transplant team will assess your physical and psychological health and administer tests, including blood work, cardiac tests, and CT scans. This process will help us determine if you’re healthy enough for a lung transplant and if your condition requires one. 

After your evaluation is complete, we’ll let you know if you’re a candidate for a lung transplant. In some cases, if you have a health challenge that affects your eligibility, we may be able to help you overcome that issue. For instance, if you have a high body mass index (BMI), a dietitian on our team can help you to achieve a healthier weight. 

If you meet the transplant criteria, you’ll be placed on the United Network for Organ Sharing (UNOS) waiting list. 

The Temple transplant evaluation team may also find that another treatment may be more appropriate for you at this time. That could include an adjustment to your medication treatment plan or a lung procedure other than a transplant. 

Q. Am I too old for a lung transplant?

By itself, age does not determine whether you can have a lung transplant at the Temple Lung Center. Some transplant centers will not perform lung transplant surgery in patients older than 65. This is because a higher age does tend to involve more health issues that can increase the risk of surgical complications. But we do not turn people away just because of their age. We evaluate the whole person and have performed lung transplant surgery on patients who are up to 80 years old. 

Q. How long will I have to wait for a transplant?

Wait time varies from person to person. Many people receive a lung transplant within six months of being placed on the UNOS waiting list. However, other patients wait for an extended period — in some cases, people may wait for years. Your wait time depends, in part, on your place on the waiting list (which is determined by your lung allocation score, a calculation based on such factors as your age and the severity of your lung disease) and on how long it takes to find a lung donor match. 

Q. How do I pay for a lung transplant? 

Most insurance plans will cover the transplant procedure. Some costs are not necessarily covered, such as medications and office visits, and patients do need to prepare for these out-of-pocket expenses. At Temple, we also encourage patients to plan for nonmedical out-of-pocket expenses, such as lodging. Our financial staff work with your health insurance company to determine what is covered and, along with your social worker, help you explore other resources that may be available. 

Q. What sets Temple’s lung transplant program apart? 

Many things distinguish the Temple Lung Center from other lung transplant centers. First, there's our experience: The Temple Lung Center has led the nation in both volume and outcomes in lung transplantation for several years. Second, our expertise is unparalleled. Temple’s world-renowned pulmonologists and surgeons are extremely skilled. We take on some of the most challenging cases and do things few other transplant centers can do. 

For example, we help patients who need pretransplant ECMO (extracorporeal membrane oxygenation) and those who need heart surgery at the same time as their lung transplant.

Q. Do both lungs get transplanted or just one?

Whether you receive one or two donor lungs depends on your condition and organ availability. Even though both lungs are diseased, sometimes only one healthy donor lung is available. If that happens, you may only receive a single-lung transplant. In these cases, Temple’s surgeons will replace the more diseased, compromised lung.

The majority of the lung transplants we do at the Temple Lung Center are single-lung transplants. But rest assured that our surgeons have the experience to do double-lung transplants, a procedure that can take up to 10 hours to complete. 

Q. Do lung transplant patients come to Temple from other parts of the country? If so, where do they stay?

Yes, we see patients from other states who need a lung transplant. We will see patients from anywhere, including other countries. However, patients on the UNOS transplant list must be able to arrive at our center within four to five hours of finishing the phone call informing them that a lung is available. This includes the time it takes to get dressed, put the oxygen tank in the car, stop for gas, and deal with traffic. After your transplant, you’ll need to remain in the area for at least the first four to six months — and possibly up to one year.

These requirements mean that most patients from outside our area will either decide to stay with family who live closer to Temple or lease an apartment. 

The Gift of Life, which is the region’s organ procurement organization, also has a family house where patients can stay. Many of our patients who have to travel here from a few hours away will stay at the family house for a period of time during their transplant evaluation because it’s easier than driving back and forth between the Temple Lung Center and their home. 

Q. How long does it take to recover?

How long it takes to recover from lung transplant surgery varies from person to person. At first, patients stay in our intensive care unit, followed by time in our pulmonary care unit. The average length of stay in our hospital is about 10 days, but it can be as long as four or more weeks. Many factors can affect the length of stay and recovery, including the patient’s health before the procedure and whether they are having a single or double-lung transplant. 

Getting back to a normal routine can take six to eight weeks. During that time, people recovering from a lung transplant need help from family members or other caregivers. That’s why I encourage patients to bring their caregivers to their doctors’ visits before they have the transplant. That way, they’ll be better prepared to assist the patient at home. Strong family support, including a primary caretaker and at least two backups, is an essential element in a successful lung transplant.

Sometimes patients also need to have home visits from a nurse or physical therapist during recovery. We encourage our patients to engage in pulmonary rehabilitation or another exercise program to help them get stronger. Our Temple Lung Center team can help you get started.

Q. What will my follow-up care involve? 

After you go home from the hospital, you’ll return to Temple for frequent visits, especially during the first year. You may need weekly lab work for at least the first six months. Close monitoring by our transplant team is important to look for complications, such as organ rejection or infection.

You’ll also need to take a variety of medicines for the rest of your life, including medication to help keep your body from rejecting your transplant. Because some of these medications suppress your immune system, you’ll have to take precautions to avoid infections like colds or the flu. This includes keeping your distance from others who are ill and washing your hands thoroughly and frequently. Our lung transplant team will explain how to take care of your new lungs, which can help you to live a more normal life. 

Are you eligible for a lung transplant? 

To find out, book a visit with one of Temple’s pulmonologists. Call the Temple Lung Center at 800-TEMPLE-MED (800-836-7536) or schedule an appointment request online. 

Helpful Resources

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Kevin Carney, MSN, CRNP, CCTC

Kevin Carney, MSN, CRNP, CCTC, Director, Temple Lung Center and Nurse Practitioner, Temple Department of Thoracic Medicine & Surgery.

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