Why are lung transplants done?

Lung transplantation is designed to offer patients with end-stage lung disease and respiratory failure some hope of a meaningful extension of their lives.

When the lung transplant team has determined you are an appropriate candidate for lung transplant, they will discuss this treatment option with you in detail and will begin the search for an organ donor.

What is the transplant waiting list?

When your transplant center has identified you as an eligible candidate for a lung transplant, the Northeast Ohio Organ Procurement Agency (known as LifeBanc) enters your name and blood type on the United Network for Organ Sharing's (UNOS) computerized national waiting list. This waiting list assures equal access and fair distribution of organs when they become available. The distribution of organs is based on the lung allocation score (LAS). Your score will be determined at each visit and updated by your coordinator. The LAS ranges from 0 to 100 with the sickest patients usually receiving a score of 48 and above.

When a lung becomes available for transplantation, it is given to the best possible match, based on blood type, size, tissue (HLA) type, recipient's medical condition, cross match compatibility, the length of time the recipient has been waiting, and the number of lungs the recipient needs.

Where does the new lung come from?

Donor lungs are located through UNOS. The donor might have recently died or be brain dead, which means that although the donor's body is being kept alive by machines, the brain has no sign of life. Donors give their permission for organ donation before their death. Some state laws require that the donor's family must also give consent for organ donation at the time of the donor's death.

An organ recipient and donor must have compatible blood types and similar body sizes. At the time of death, the donor's lung is completely removed, cooled, and stored in a special solution. Immediately after the donor's lung is removed, it is transported to the recipient's transplant center where the transplant takes place as soon as possible.

Many people who are waiting for transplantation have mixed feelings because they are aware that someone must die before an organ becomes available. It might help to know that many donor families feel a sense of peace knowing that some good has come from their loved one's death.

What blood tests are performed to identify a compatible donor?

The greater the blood compatibility shared by a donor and the recipient, the greater the chance of a successful transplant.

ABO blood type

First, a simple blood test is performed to determine the blood type of the donor and recipient. Here's how your blood type should be compatible with your potential donor's blood type:

  • If you are blood type A, you can accept an organ with blood type A or O.
  • If you are blood type B, you can accept an organ with blood type B or O.
  • If you are blood type O, you can accept an organ with blood type O. (A person with blood type O is called a universal donor because he or she can donate to people of all blood types.)
  • If you have blood type AB (universal acceptor), you can accept an organ with any blood type (A, B, O, or AB).

Tissue typing

Tissue typing evaluates the compatibility, or closeness, of tissue between the organ donor and recipient. An HLA (human leukocyte antigens) blood test is used to determine tissue type and help find the best genetic match for you. Regardless of how compatible a donor organ is with a recipient, it is never possible to have a perfect match, since no two people are completely identical.

Continuing research is being performed to develop medicines and treatments that can boost the success rate when the tissue match is not very close.

How long will I have to wait before I receive my transplant?

Locating a suitable donor takes time. It is impossible to predict how long a wait there will be before a lung becomes available. The average wait is about three to six months for patients with IPF or certain diseases; however, it's possible the wait could be from a few days to many years depending on your LAS and your disease. Some people might have to wait longer than others for their transplants because their blood and tissue types might be less common, so it takes longer to find a compatible match.

Even when a donor is located, the surgery might not take place. If there is a problem with the donor lung or if you have an infection, the surgery cannot be performed. About 20% of all lung transplants are canceled the first time. If this happens, you must wait for another donor organ to become available.

Does it matter who the lung comes from?

You do not need to be concerned about the gender, age, or race of your lung donor. Remember, the lung you will receive has been matched as closely as possible to your characteristics, including body size, tissue and blood type.

What is an increased risk donor?

The Public Health Service definition of an increased risk donor says that an increased risk donor is a donor who may have had certain behaviors that increases the risk for blood borne disease transmission. Your provider will speak to you if an increased risk donor has been identified for you. During the discussion, you and your doctor will discuss the reason your donor is considered increased risk and what the risk is to you and the protocol to follow for your blood tests if you accept an increased risk donor. If you refuse an increased risk donor, we will continue to look for an appropriate organ for you with no ramifications. You will learn more about increased risk donors throughout your evaluation and after being listed for a transplant.

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