What are the treatment options available for end-stage lung disease?
- Medical management
- Pulmonary Rehabilitation
- Oxygen therapy
- Lung transplantation
Who can be considered for lung transplantation at Baylor St. Luke’s Medical Center?
In general, a good candidate:
- Has severe end stage lung disease with limited life expectancy
- Has not been helped by all medical and surgical treatments
- Has a good support system and is mentally prepared to undergo the transplant process and a complicated post-transplant regimen
- Has medical insurance that will cover the cost of the transplant and the post-transplant care and medications
- Is medically stable and does not have any other illness or organ failure
- Does not smoke, use drugs or abuse alcohol
- Does not have any active infection or recent cancers
- Be willing to accept the risks of surgery and subsequent medical treatment
- Be physically capable of undergoing surgery and subsequent medical treatment
How do I start the evaluation process?
In most cases, your personal pulmonologist will make the first inquiry about a transplant. Information that will be required from your pulmonologist includes your insurance information, medical history, current condition, and recent test results.
What should I expect during the evaluation process?
A standard set of tests including labs and radiology imaging give a clear picture of your overall health status. They also help to identify potential problems before they occur. We try to determine whether or not transplantation is truly the best option for you.
What tests should I expect to have done during my evaluation?
- Lung function tests, chest x-ray, cat scan of chest, echocardiogram, blood test, laboratory tests, lung scan, and a heart catheterization. You will also consult with the transplant social worker or psychiatrist, dietician, and financial counselor.
- Everyone is different, therefore every evaluation will be tailored to each individual.
Who determines if I am a transplant candidate?
Medical Review Board will determine if you are a transplant candidate. When your evaluation is complete, your case will be presented to the Board. The Medical Review Board consists of transplant pulmonologists, transplant surgeons, a transplant coordinator, dieticians, social workers, and financial counselors. Their goal is to determine the best treatment option for you and they will determine if you are a candidate for transplant.
How long is the wait for a transplant, if accepted?
- If you are accepted for transplantation, you will be placed on a national computer list of active candidates waiting for a suitable donor. Recipients are chosen according to a complex set of criteria, including blood type, body and organ size, medical condition, and length of time on the waiting list. The United Network for Organ Sharing (UNOS) coordinates the equitable sharing of organs throughout the United States and oversees all donor centers and procurement agencies. For more information, visit http://unos.org.
- The waiting period can be several months to several years, while the transplant team searches for the appropriate lungs for you. The transplant coordinators must be able to locate you 24 hours a day and you must be able to reach the hospital within a reasonable amount of time.
What are my responsibilities while waiting for transplant?
While on the transplant list, you must maintain active medical insurance. Failure to do so may impact your ability to receive a new lung. You will be put on a regimen of "healthy living" that will get you into the best possible physical condition for surgery, with exercise, good nutrition, no smoking, and limited to no use of alcohol.
You must notify the transplant center if there are any changes in:
- Address or phone number
- Medical condition
- Surgeries/ hospitalizations
- Blood transfusions
What is the process like when a lung is found for me?
When a potential donor is found, the coordinator will call to notify you, (it is very important to keep us aware of any change in address or phone number).
Once contact is made, the coordinator will instruct you on where to report and ask you not to have anything else to eat or drink prior to the transplant.
When you come for surgery, please remember to bring:
- A current medication list
- A list of your drug allergies
- Current health insurance information (your most recent insurance cards)
What happens when I get to the hospital?
After admission, the patient will have blood work, chest x-ray and an EKG and an IV inserted. Unfortunately in some cases, the surgery has to be cancelled after you have arrived at the hospital.
Some reasons are:
- Donor lungs become unsuitable for transplant before or at visualization of donor lungs
- Additional medical problems
What will my surgery be like?
A transplant operation will require many hours — about 1 hour to prepare you for anesthesia and to attach necessary monitoring lines; 3 - 6 hours for surgery for a single lung and 4 - 10 hours for a double-lung transplant. Additional time may be required if you have had prior chest surgery.
How long will I be in the hospital after my surgery?
- After your transplant, the recovery time varies. Some patients may be discharged from the hospital within 10 - 14 days and others require longer recovery times.
- If you live out of the Houston area, you are typically required to stay in the area for approximately 3 months.
What medications will I be on after transplant?
Post transplant, you will be on several different medications:
- Immunosuppression medications- These medications will keep your body from fighting off your new organ. These may include Neoral, Prograf, Cellcept, Imuran, Rapamune, and Prednisone
- You may be on other medications to control blood pressure, manage cholesterol, antibiotics, anti-virals, anti-fungals, diuretics, and vitamins and minerals.
How much will my medications cost?
Medication expense will vary according to your healthcare insurance and supplemental funding. If you need more assistance, please see our information on financial considerations for transplant.
What will be expected of me after transplant?
You will have to follow up frequently for lab work, clinic visits with testing and scheduled bronchoscopies with biopsies. Bronchoscopies are done to determine if there is any rejection and/or infection and are usually done as an outpatient procedure after you are discharged from the hospital. These will be done frequently during your first year after transplant up until 3 years post transplant. You will need to have lab work drawn every one to two weeks for the first three months after transplant and will be seen in the transplant clinic every month for the first year.
There are several factors that will help you keep your new lungs healthy. It will be important to follow a healthy lifestyle. You will need to exercise regularly, maintain a healthy diet, and keep a weight that is appropriate for your body frame. You will be expected to help your transplant team monitor your care by keeping records of your spirometry, blood pressure, weight, temperature, and pulse.
When will I be able to return to work or school?
This time will vary for each person. Ideally you should be able to return to work or school about three months after transplant if your condition is stable. Most patients are able to return to a healthy level of normality about this time.