Multi-Organ Transplant

Lung Transplant - Patient Information

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The Multi Organ Transplant Program has pioneered the field of lung transplantation. In 1983, the world's first successful single lung transplant was performed, with the world's first successful double lung transplant to follow shortly thereafter in 1986. Two years later, in 1988, double lung transplantation would be introduced as a treatment option for patients with cystic fibrosis. Today, the program performs over 80 lung transplants per year and is a leader in innovative treatments.

Many of our patients come from different parts of Ontario and other provinces. Our respirologists use a system called Telehealth (internet video conferencing) to assess and discuss transplantation with these patients, their support persons and their local health care professionals.

Indications
Patients under consideration for single and double lung transplant present with a variety of lung diseases. The following list outlines some of the lung diseases that may be referred for lung transplantation.

1. Chronic Obstructive Pulmonary Disease (COPD)

	Emphysema
	Alpha 1 Antitrypsin Deficiency
	Bronchiolitis
	Lymphangioleiomyomatosis
	Eosinophilic Granuloma

2. Interstitial Lung Diseases

	Idiopathic Pulmonary Fibrosis
	Sarcoidosis
	Scleroderma

3. Airway Diseases

	Bronchiectasis
	Cystic Fibrosis

4. Pulmonary Hypertension

	Idiopathic
	Secondary
	-	Eisenmenger's Syndrome
	-	Scleroderma

Assessment
Pre-transplant evaluation consists of a variety of medical tests and interviews with members of the transplant team. This process is essential in determining a patient's suitability for lung transplant. During the evaluation process the potential candidates and their support persons will be provided with information to assist them in making informed decisions about transplantation. They will be given a lung transplant manual by the transplant coordinator during the time of the assessment. This manual will cover pre and post-transplantation issues. The patient and their family are encouraged to ask questions of the team members. It is mandatory that a support person(s) is present during the time of assessment. This is a person who is involved in the patient’s care. This may be a spouse, family member, parent, or friend.

Support people undertake a large responsibility in caring for a loved one. The lung transplant team recognizes this, and so has put together a special manual designed to help the support person in caring for themselves. This is given to the support person during the evaluation.

Download Lung Transplant Manual

Patients with chronic infections (e.g. cystic fibrosis) are generally treated by double lung transplant. Patients with emphysema or interstitial lung disease may be managed by either a single or double lung transplant.

The workup process typically involves the following tests but may require additional testing if other health issues are of concern. Please see the glossary for definitions.

	Pulmonary Function Tests
	Chest X-Ray
	Arterial Blood Gases
	Lung Perfusion Scan
	CT Scan of Chest
	Six Minute Walk
	ECG
	RNA-First-Pass and Exercise (MUGA Scan)
	2D Echo with Doppler
	Coronary Angiogram
	Cardiac Stress Test – Dobutamine MIBI
	Bone Density Scan

The Transplant Team Members who consult on lung transplant evaluation are:

	Respirologist
	Anaesthetist
	Transplant Coordinator
	Social Worker
	Psychiatrist / Psychiatric Nurse
	Cardiologist
	Physiotherapist
	Nutritionist
	Advanced Practice Nurse
	Dietician

Waiting List
There are usually 50-60 patients on the waiting list for lung transplant within our program. The waiting period for a donor varies in length because the donor pool is limited and the selection criteria for a matching donor are strict. The average waiting time is 4-5 months, but can range from days to 2 years. Once accepted as a lung transplant candidate, patients must live within a 2.5hr limit of downtown Toronto to facilitate access to the transplant team for ongoing monitoring, support and education, as well as to be readily available when called for transplant. For many patients this means relocating for the waiting period, and postoperative period for about 3 months. It is mandatory that patients relocate with a support person(s). Patients must participate in a physiotherapy program 3 times a week pre and post surgery. They will be followed in clinic for management of their lung disease. There are routine tests that are done pre- transplant to monitor the patients’ lung disease.

Relocation is required by many patients. This may involve the selling and purchasing of homes, renting apartments or houses, and changing schools for children or jobs for other family members. Relocation will be discussed in great detail between the patient, family members, support person, social worker, and the rest of the lung transplant team.

All patients assessed and listed for lung transplant must have a support person. This could either be a family member or close friend. A support person provides help with day-to-day tasks such as cooking, cleaning, and transportation to hospital appointments. This carries on for several months after the transplant until patients are well enough to do these things on their own. The support person also provides emotional support and friendship. Everyone needs emotional support as they proceed along this transplant journey. The transplant program assists support people during the assessment by meeting with a social worker. All support people are given a booklet to help them understand their role and provide them with further information.

Download Caregiver Booklet

Surgery
Lung transplant surgery may last anywhere from 6 to 12 hours. The following are brief descriptions of the surgical process for both single and double lung transplant procedures.

Single Lung Transplant
Patients first undergo an incision to the chest to remove the diseased lung and prepare the site for transplantation of the new lung as the donor lung arrives in the operating room. There will be 3 places of connection to attach the new lung:

	The donor main bronchus is attached to the recipient's main bronchus
	Recipient pulmonary artery is attached to the donor pulmonary artery, and
	Donor pulmonary veins are attached to the recipient's left atrium.

Double (Bilateral) Lung Transplant
A double (bilateral) lung transplant involves replacing each lung separately. As the donor lungs arrive in the operating room, the recipient's first lung is removed. Patients may undergo some form of heart/lung bypass during the procedure. After removal of the first lung, one donor lung will be attached. There will be 3 places of connection as in single lung transplant. At this point, blood flow is restored to this first new lung. The recipient's second diseased lung is then removed. The second new lung is attached as with the first one. Once the second lung is completely connected, blood flow is restored to it.

Recovery
Lung transplant recipients can expect to be in the hospital for approximately 2-3 weeks after surgery. Immediately after the transplant procedure, patients are on a ventilator to assist with their breathing and their vital signs (heart rate, breathing rate and oxygen saturations) are carefully monitored in the intensive care unit. Once stabilized and off of the ventilator, patients are then transferred to the Transplant Level 2 Critical Care Unit and then the Multi Organ Transplant Unit. Patient care following transplantation focuses on:

	Monitoring for Rejection
	Adjusting Immunosuppressive Therapy
	Education and Teaching
	Rehabilitation
	Support

Discharge & Follow-up
Discharge planning begins well in advance when the patient is undergoing assessment. The program's Patient Resource Coordinator assists in assessing patients' readiness for discharge and ensuring patient teaching is complete.

Post transplant is a very busy period for patients. There is regular bloodwork, clinic visits, physiotherapy, and other appointments every week for the first 3 months, so the lung transplant team can quickly identify and manage any issues that may arise. Your post transplant coordinator will help you with your new routine. During clinic appointments, patients are seen by their transplant coordinator and transplant physician. Communication with the patient's family physician and other specialists is an important component of follow-up care. Patients keep in contact with their transplant team through our patient voicemail system, Easy Call.

The Multi Organ Transplant Program's team approach ensures that patients receive comprehensive follow-up care after transplantation and throughout their lives post-transplant.

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