Heart And Lung Transplant

Alternate Names
heart-lung transplant

Definition of Heart And Lung Transplant

A heart and lung transplant is a surgical procedure in which a person's poorly functioning heart and lungs are replaced with those a person who has been declared brain dead, usually following an automobile crash or other major trauma, and had previously declared an intention to donate their organs at the time of death.

Who is a candidate for the procedure?

A heart and lung transplant is a serious operation, reserved for those who will die without it. The procedure is expensive and risky, demanding that an individual undergo intense treatment for many years following the procedure.

Candidates for the operation are people who have serious diseases that involving both lungs and the heart. Examples include:

• severe congenital heart disease, or heart defects present at birth
• severe high blood pressure in the lung arteries, known as pulmonary hypertension

To be considered for the operation, a person must be under age 45, and in good health in aspects other than heart and lungs. In addition, a person must be able to adhere to the schedule of complex medication treatments and frequent visits to the healthcare professional that will be needed after the transplant.

The procedure cannot be done until a suitable organ donor is found.

How is the procedure performed?

The transplant is done under general anesthesia, meaning that the person is put to sleep with medications and has no awareness nor pain during the operation. After the patient is put to sleep, the chest area is cleaned with antibacterial chemicals.

Next, an incision is made into the breastbone or sternum to expose the heart and lungs.

The person is then put on a heart-lung bypass machine. This device keeps the blood supplied with fresh oxygen and moving throughout the blood vessels of the body at an appropriate pressure, until the heart can be reconnected.

The surgeon can then take out the person's heart and lungs. The replacement heart and lungs are put into the chest and sewn into place. After the new heart and lungs are connected, the person is taken off the heart-lung bypass machine.

Once the person's heart is working again to pump the blood, the surgeon checks for any bleeding. If everything is working properly, the chest incision is closed.

The person is awakened from the anesthesia and taken to the surgery recovery room or surgical intensive care unit.

What happens right after the procedure?

The person will spend at least an hour in the surgery recovery room until the anesthesia has worn off. Once the person is breathing well, the ventilator is turned off and the person can breathe normally. The person must stay in the hospital several days or even weeks to recover. Pain medications are given as needed for pain. Medications to suppress the immune system are given to prevent the body from rejecting the new organs.

What happens later at home?

Individuals who have had this surgery must stay on medications for the rest of their lives to prevent rejection of the new organs. Frequent visits to the healthcare professional, blood tests and x-ray tests are required for monitoring. Activity is gradually increased as tolerated.

What are the potential complications after the procedure?

The most important complication is death, which can occur during surgery or afterwards, most often from infection or rejection of the new heart and lungs.

As of 2005, 53% of people are still alive 3 years after a heart-lung transplant. Complications, as with any surgery or anesthesia, include bleeding, infection, and reactions to the anesthesia medications.

The medications that must be taken to prevent rejection have many side effects. These include allergic reactions, stomach upset, and kidney damage. Other side effects depend on the medications used. Because these medications suppress the immune system, the person's increased risk for infection lasts for life.