Bronchial Tubes Enlarged

How the lungs function

Your lungs' main job is to make oxygen available to your body and to remove other gases, such as carbon dioxide. This process is done 12 to 20 times per minute.

When you inhale air through the nose or mouth, it travels down the back of the throat (pharynx), passes through the voice box (larynx) and into your windpipe (trachea).

Your trachea is divided into two air passages (bronchial tubes). One bronchial tube leads to the left lung, the other to the right lung. The right lung has three sections, called lobes, and is a little larger than the left lung, which has two lobes. The bronchial tubes divide into smaller air passages (bronchi), and then into bronchioles. The bronchioles end in tiny air sacs called alveoli, which pump oxygen from the inhaled air to the blood.

After absorbing oxygen, the blood leaves the lungs and is carried to the heart. Then, it is pumped through your body to provide oxygen to the cells of your tissues and organs.

After the oxygen is delivered to the cells, other gases are still in your blood. Your blood carries these gases back to your lungs and removes them when you exhale.

The respiratory system has built-in methods to prevent harmful substances from entering the lungs:

  • The hair (cilia) in your nose helps filter out large particles.
  • Mucous produced by cells in the trachea and bronchial tubes keeps air passages moist and aids in intercepting dust, bacteria and other substances.
  • Cilia in the air passages move in a sweeping motion to keep the air passages clean. If substances such as cigarette smoke are inhaled, the cilia stop functioning properly.

Healthy lungs vs. unhealthy lungs

Each person is born with two lungs, but can survive with only one as long as that lung is healthy.

Healthy lungs are made of a spongy, pinkish-grayish tissue. Lungs that have become polluted with harmful carcinogens (substances that can cause cancer) or carbon particles have blackened spots on the surface. Healthy lungs may also have blackish spots, however, they are sporadic and not as abundant as in unhealthy lungs.

Healthy lungs are elastic so they can expand when you inhale; in contrast, a disease like emphysema causes the lungs to lose their elasticity. When a lung can no longer expand properly or transfer oxygen to the blood, that person has difficulty breathing and tires easily; in some cases, he or she cannot walk more than a few steps at a time. Other difficulties may occur because the tissues and organs aren't getting the oxygen they need.

In some lung disorders, removing part or all of the lung can effectively treat the problem. But if a disease affects both lungs, or when medical treatment has not improved the lung condition, the best treatment choice may be a lung transplant.

Lung transplant as a treatment option

A lung transplant may be recommended for patients with diseases such as cystic fibrosis, pulmonary fibrosis, chronic obstructive pulmonary disease (a group of diseases that includes emphysema) or pulmonary hypertension.

Before a lung transplant, you can expect to have a pre-transplant evaluation, which includes a complete physical, consultations with members of the Lung Transplant Team and a series of tests. A pre-transplant evaluation provides complete information about your overall health and helps determine if you are eligible for a lung transplant.

After your healthcare provider has determined that you are a good candidate for a lung transplant, the search for a donor will begin. Locating a suitable donor takes time and the waiting period may be stressful.

After a donor is found, things move quickly. You'll come to the hospital immediately, undergo surgery, and remain in the hospital for two to three weeks or longer, depending on your recovery.

During your recovery, you will learn about your new medications, how to recognize signs of complications, and when you can return to your normal activities. After you go home, you can expect to recover gradually, usually over three to six months.

Follow-up care after your transplant includes appointments with your physician and tests to assess how your new lung is functioning and how the medications are working.

Preparing for your Transplant

How can I prepare myself while I’m waiting for my transplant?

Waiting for a donor organ can be a stressful experience, especially because the amount of time you’ll have to wait is unknown. There are many things you can do to prepare yourself while you wait for a donor lung to become available. Changing your lifestyle before your transplant will help you adjust after the transplant.

Below are some guidelines to follow:

  • Try to stay as healthy as possible by carefully following the recommendations of the Lung Transplant Team.
  • Take your medicines as they are prescribed and notify your transplant coordinator if antibiotics are prescribed, if your steroid dose changes or if you are hospitalized for any reason.

Follow the dietary guidelines provided by your dietitian

  • Weight management is very important while waiting for your transplant. Your dietitian will recommend a weight range for you to maintain.
  • We require that you quit drinking alcohol, especially if you drank heavily in the past (two or more drinks per day, including beer and wine).
  • Perform your breathing exercises and maintain your exercise program, as directed by your physician.
  • Stop and rest if you experience any discomfort, shortness of breath or chest pain during any activity.
  • A physical therapist can work with you to plan and develop an exercise program that will give you the greatest benefit before and after transplantation.
  • Continue your enrollment in a local pulmonary rehabilitation program and remain firm in your commitment to the program.

Keep all of your appointments with your healthcare providers

Until your transplant, you will meet with the transplant pulmonologist and transplant coordinator every two months in order to evaluate your overall health.

  • Make sure you are available.
  • It is important for the Lung Transplant Team to know how to get in touch with you at all times.
  • Your Transplant Team should have the telephone numbers of where you can be reached 24 hours a day, as well as the names and telephone numbers of family members who can reach you.
  • You must obtain a pager or cell phone so we may contact you immediately should organs become available for your transplant.
  • We encourage you to purchase a telephone answering machine with remote access so you can check your messages frequently when you are away from the telephone.
  • Be sure to inform us of your pager and/or cell phone numbers.
  • If you plan to be out of town (even for one day), give a phone number to the transplant coordinator.
  • Your transplant coordinator may recommend that you stay within a certain geographic range.

Be prepared with transportation

  • When you are placed on the organ waiting list, your first responsibility is to plan how to get to Cleveland Clinic as soon as you are notified that a lung is available.
  • Prepare yourself for this call by making the necessary arrangements for transportation well in advance.
  • If you live less than 1-1/2 hours away from Cleveland Clinic, the transplant coordinator on call will arrange transportation for you and one family member.

Be prepared by packing your bags in advance

  • You'll need to be ready to leave as soon as you get the call that a lung is available.
  • Be sure to include your insurance information and a 24-hour supply of medication.
  • If you need oxygen, make sure you have enough to get you to and from the hospital (in case the surgery is cancelled).
  • All necessities, such as pajamas and bedding, are provided and laundered for you. However, you may prefer your own pajamas, slippers, robe or other comfortable clothing (provided you have someone to do your laundry for you).
  • Please bring your toothbrush, toothpaste and any other toiletries you may need.
  • You should expect to stay in the hospital two to three weeks.
  • Because the hospital is not responsible for lost or stolen personal items, please do not pack valuable jewelry, credit cards, checks or large amounts of cash.
  • You also may want to pack a book, magazine and a family picture or other comforting reminder of home to keep at your bedside.

Learn all you can about the transplantation process and ask for support

Ask your social worker about support groups and other resources so you can receive more information and learn about other transplant recipients' experiences.

Occupy yourself

If possible, don't turn your back on your favorite activities. You can spend the time doing what you enjoy. Now may be a perfect time to learn a new hobby or continue your old hobbies. The time will pass quickly if you spend it doing things you enjoy.

For More Information

If you have any questions or concerns, please call us at 216.444.8282. We will be happy to answer your questions.

Transplant Surgery

Getting the call

When a lung has been identified for you, a transplant coordinator will contact you by telephone or pager. Remember, this could be any time of the day or night.

As soon as you receive the call, do not eat or drink anything (not even water).

Your stomach must be empty before surgery.

It is normal to feel both excited and scared. Because of the natural confusion caused by the need to get to the hospital quickly, you may feel rushed and confused. You’ll be glad you planned ahead to get to the hospital with minimal delay, knowing you have left your home in order.

Getting to the hospital

As soon as you receive the call, bring your suitcase that you’ve packed ahead of time and come directly to Cleveland Clinic. Even though the donor lung receives special handling, there is a time limit.

If you live more than 1½ hours away from the hospital, the transplant coordinator will arrange transportation for you and one family member. If you live less than 1½ hours away, you must have someone drive you quickly but carefully to the hospital.

When you arrive at the hospital, go to Desk G-50 where you will be admitted.

What happens before surgery?

You will wait in the Transplant Unit until the final results of the crossmatch are determined. If the crossmatch results are negative (or compatible), you will be prepared for surgery (generally within a few hours of your admission).

Just before surgery, you will be asked questions, and tests will be ordered to make sure you are in the best possible physical and emotional condition for the transplant.

If you have a cold, sore throat, fever or any type of infection, it is very important to tell the nursing staff. It also is very important to tell the staff about any other problems you may have.

A complete physical, chest X-ray, blood tests and an electrocardiogram (EKG) will be completed, and the results will be reviewed by your doctor.

While you are being prepared for surgery, a Cleveland Clinic transplant surgeon will remove and prepare the donor lung.

If you have a significant medical problem or any signs of infection, or if the donor lung is determined to be unacceptable, the surgery will be canceled. It is better to wait until another lung becomes available than to risk a transplant when you are not physically ready.

Before you go to the operating room, you will be asked to:

  • Wear a hospital gown
  • Empty your bladder
  • Remove your dentures or partial plate
  • Remove your eyeglasses or contact lenses
  • Remove jewelry, makeup, nail polish and hair pins

To prepare you for the transplant surgery, the incision area will be shaved (from your chest to your knees) to prevent infection. You also will have an intravenous tube (IV) inserted in your arm to deliver fluids and medication. Before going to the operating room, you will be given a sedative to help you relax and make you sleepy.

What happens during surgery?

An anesthesiologist will inject general anesthesia (pain-relieving medication) through your IV, which will make you go to sleep. After you are asleep:

  • A central venous catheter is inserted into a vein in your neck or groin. This type of catheter is used to deliver fluids, nutrition solutions, antibiotics or blood products directly into your bloodstream without frequently having to insert a needle into your vein.
  • A tube is placed in your mouth that goes down your throat and into your windpipe (trachea) to help you breathe. The tube is attached to a ventilator that will expand your lungs mechanically.
  • You are placed on a heart/lung machine to allow surgeons to bypass the blood flow to the heart and lungs.
  • A nasogastric tube is inserted through your nose into your stomach. This tube drains secretions from your stomach.
  • A tube called a catheter is placed in your bladder to drain urine.
  • The surgeon carefully removes your lung and replaces it with the donor lung.

Where can my family wait?

Family members and friends are invited to wait for you in the Family Waiting Lounge until the surgery is completed. This waiting area has a play room for small children, a television, reading materials and comfortable chairs.

The surgery lasts six to 12 hours. Cleveland Clinic has several cafeterias and restaurants, a gift shop and a Health Information Desk that may be of interest. We ask visitors to sign in and out of the waiting area, and provide a phone number so we can contact them if necessary.

A member of the transplant team will meet with your family in the Lounge to keep them updated on your condition. Your family will be notified when the surgery is complete.

For More Information

If you have any questions or concerns, please call us at 216.444.8282.
We will be happy to answer your questions.

After the Surgery

After surgery, you will be taken to the Intensive Care Unit (ICU) where you are closely monitored. You will be very drowsy during this time and will be sleeping most of the time.

Special monitoring equipment will check your pulse and blood pressure every 15 minutes. Occasionally, this monitoring equipment will beep or sound an alarm. This does not necessarily mean anything is wrong. Regularly, an electrocardiogram will be done to measure your heart rhythm and rate.

Your weight, and your intake and output of fluids will be checked frequently so your doctor can determine how well your heart and lung are functioning.

The IV in your arm and the catheter in your neck or groin will still be in place to deliver fluids and medicines. The catheter also helps your doctor determine the pressure in your heart chambers to evaluate its function.

You will have a tube in your throat leading to your windpipe (called an endotracheal tube). This tube is connected to a ventilator to help you breathe and receive the right amount of oxygen. At first, you might feel like you aren’t getting enough air. It takes time to get used to the machine. Try to relax and breathe with the ventilator to make it easier to breathe.

When you are connected to the ventilator, you will not be able to talk. To communicate with your nurse, you can nod or shake your head to indicate "yes" or "no." Although this tube might be uncomfortable, it is necessary to help you breathe. As your lungs expand and when you are breathing on your own and getting the oxygen you need, you will be taken off the ventilator (usually in one to two days).

You will have a dressing over your incision site. The nurse will check the incision frequently to detect bleeding.

The nasogastric tube and urinary catheter will remain in place for a few days up to a week, until your bowel and urinary functions have returned to normal. If the catheter feels uncomfortable, tell your nurse so it can be adjusted.

A chest drainage tube will remain in place for a few days to drain the fluid and blood that collect after surgery around the lungs.

Once your transplant team has determined your condition is stable, you will be transferred from the ICU to your room in the Transplant Unit. At times during your recovery, you might need to return to the ICU for specialized monitoring to ensure your best recovery.

Key Data

For information on key data for the lung program and other solid organ transplants please visit, www.ustransplant.org. This third party resource evaluates all solid organ transplant programs in the United States. You will be able to find solid organ transplant outcome information including; number of transplants performed, survival rates, wait list times and other vital statistics. In addition, you will be able to research OPOs across the country and compare programs regionally and nationally.