Lung Transplant Surgery
What should I do when I get the call for my lung transplant surgery?
The followoing presented as general information and may vary from your healthcare institution's transplant team. Follow your own transplant team's instructions exactly.
When a lung has been identified for you, a transplant coordinator will contact you by telephone. Remember, this could be any time of the day or night. Please make sure your phone numbers are always up to date.
As soon as you receive the call, do not eat or drink anything (not even water) unless instructed by the coordinator. 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 might 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.
How quickly should I get to the hospital?
As soon as you receive the call, bring the suitcase you packed ahead of time and follow the timeline outlined by your coordinator to get to the hospital. Even though the donor lung receives special handling, there is a time limit. Always follow the timeline outlined by your coordinator to get to the hospital in time
If you live more than four hours away from the transplant center, the transplant coordinator on call will arrange transportation for you and one family member. If you live less than four hours away, you likely will need to be driven to the hospital. Have someone drive you carefully there.
What happens before lung transplant surgery?
You will wait in the transplant unit until the transplant team has visualized the lung or lungs, and determined they are appropriate for transplant. While you are in the transplant ICU, a complete physical, chest X-ray, blood tests, and an electrodardiogram (EKG) will be completed, and the results will be reviewed by your doctor.
If the donor lungs appear acceptable on direct visualization then you will be taken to the operating room within one to two hours. Your family can stay at your bedside until you are taken to the operating room.
Just before surgery, you will be asked questions and undergo tests to make sure you are in the best possible physical and emotional condition for the transplant. You will meet a surgical team member who will consent you for the procedure.
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 This is termed a "dry run." You will be informed personally by a physician if your surgery is canceled due to a “dry run." It is better to wait until another lung becomes available than to risk a transplant under these circumstances.
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.
If you had previously consented to participate in a clinical trial, the trial information will be discussed again with you.
To prepare you for the transplant surgery, the incision area will be shaved (from your chest to your knees) to prevent infection. You will also have an intravenous tube (IV) inserted in your arm to deliver fluids and medicine. 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 medicine) 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 might be placed on a heart/lung machine to allow surgeons to bypass the blood flow to the heart and lungs. The machine pumps blood through the body, removing carbon dioxide (a waste product) and replacing it with oxygen needed by body tissues.
- 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.
How long does the surgery last?
The procedure lasts about six hours. Family members and friends are invited to wait for you in the facility's waiting lounge until the surgery is completed. 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 waiting area to keep them updated on the progress of your surgery. Your family will be notified when the surgery is complete and when they can visit you in the intensive care unit.
Risks / Benefits
What are the risks of lung transplant surgery?
Lung transplantation is a complex process, and risks accompany the procedure. The transplant team will discuss with you the potential risks and possible benefits of the procedure. Please ask questions to make sure you understand the potential risks and benefits.
Recovery and Outlook
Where will I receive care after my lung transplant surgery?
After your surgery, you'll receive care in the intensive care unit (ICU) of your healthcare institution and then into a post-transplant unit or program. This unit is designated for all transplant patients. The staff in this unit is experienced in meeting the unique needs of lung transplant patients and their families. Once you're stable and no longer needing ICU care, you'll go to this post-transplant unit to learn more about your transplant and medications.
Now that I feel better after my lung transplant surgery, when can I return to my regular activities?
You can resume your previous activities as soon as you feel better, but remember that your recovery will take several months and you should increase your activity gradually.
A daily pulmonary rehabilitation program, prescribed by your physical therapist, will strengthen your lung and continue to improve your overall health as you recover at home.
You won't injure yourself or your new lung if you follow these general guidelines:
- Don't lift anything over 5 pounds (including your suitcase when you leave the hospital) and avoid strenuous physical work for at least six to eight weeks after surgery. Don't lift anything heavier than 10 pounds after six months from the date of your surgery.
- Avoid driving for at least six weeks after surgery. Plan ahead so a friend or family member can help out during this time. Always wear your seat belt when you're in a motor vehicle.
- Gradually increase your physical activities after your incision has healed. Exercise is encouraged. We recommend beginning with stretching exercises and walking to help you regain your strength. Pay attention to how you feel when exercising. Stop and rest when you feel tired or in pain. Avoid strenuous physical work for at least six to eight weeks after surgery.
- As a general rule , rough contact sports should be avoided since they might cause injury to your transplanted lung. If you have doubts about any activity, please ask your doctor or transplant coordinator.
- Keep your home and work environments smoke-free. Don't go near areas where there are fumes or smoke, and avoid areas where people are smoking.
- Follow your doctor's guidelines regarding your diet, level of activity and returning to work.
- Call your doctor if you have a temperature over 100°F, have a cough that is different from other coughs you had before the transplant; are feeling overly tired or short of breath; are dizzy; or have any sores, blisters, new growths or lumps. (Check your neck, armpits and groin. Women should also check their breasts for lumps.) Go to the emergency room if you have a cut that is deep or bleeds heavily.
See your family doctor for a complete physical every year after your transplant .
What should I do if I have trouble sleeping ?
Many people complain of having trouble sleeping for some time after surgery. You might experience insomnia (an inability to sleep) because of discomfort related to healing, stress from personal concerns, or side effects from your medicines.
If you cannot sleep, try these tips:
- Establish a regular sleep schedule. Go to bed and get up about the same time every day.
- Make sure your bed and surroundings are comfortable. Arrange the pillows so you can maintain a comfortable position.
- Keep your bedroom dark and quiet.
- Use your bedroom for sleeping only. Don't work or watch TV in your bedroom.
- Avoid napping too much during the day. At the same time, remember to balance activity with rest during recovery.
- If you feel nervous or anxious, talk to your spouse, partner or a trusted friend. Get your troubles off your mind.
- Listen to relaxing music.
- Do NOT take sleeping pills. They are very harmful when taken with your other transplant medicines.
- If you can't sleep, get up and do something relaxing until you feel tired. Don't stay in bed worrying about when you're going to fall asleep.
- Avoid caffeine.
- Maintain a regular exercise routine, but don't exercise within two to three hours before bed time.
When will I be able to return to work after my lung transplant surgery?
Many lung transplant patients are able to return to work within a few months after surgery. However, various aspects of the recovery process can affect the timing of your return.
You will need to discuss returning to your job with your doctor and transplant coordinator. When the time approaches, a "return to work" letter will be provided. This will let your employer know when you may begin working and what limitations, if any, you might have at work.
How soon can I take a vacation?
Travel has changed right now for everyone with the COVID-19 pandemic. If you choose to make vacation plans, be sure to follow all current government travel restrictions to minimize your risk of exposing yourself to the coronavirus (or spreading it yourself). Talk to your doctor and your transplant team for any specific recommendations. Always let your doctor or transplant coordinator know when you plan to go, and provide a phone number where you can be reached.
Here are other travel tips to help keep your vacation worry free:
- Always take all of your medicines with you, and make sure you have enough medicines to last throughout your trip.
- If you are traveling by plane, carry your medicines with you. Never check them with your luggage. You might need a letter from the transplant team that verifies all of your medicines especially if you are traveling internationally. Pack this letter with your medicines.
- Always wear your Emergency Medical Identification.
- Make sure you have the transplant center's phone number.
- Check to see if there is a medical laboratory or transplant center nearby where you can have your blood work completed. This lab will need to report your results to your transplant center.
- Be careful to avoid infection when traveling. In areas where the water might be unsafe, drink bottled water or other beverages. (Order beverages without ice.) Swim only in chlorinated pools.
- Select food with care to avoid illness.
Sexual activity after transplantation
There are no restrictions on resuming sexual activity. To avoid straining yourself while recuperating, you might want to use a low-stress position.
We recommend that you use condoms to prevent infection. Report genital rashes, sores, unusual discharge or yeast infections to your transplant coordinator.
Recommendations for female transplant patients
Even if your periods seem to have stopped, you should always use a safe and effective method of birth control after transplant surgery. We don't recommend birth control pills, because of the added risk of side effects.
Pregnancy is not recommended, especially within 1 year after transplant surgery. The medicines you take after surgery are harmful to a developing baby, and the stress of pregnancy on your body can be harmful to your health.
If you desire to have children after your transplant, there are other options such as adopting and serving as foster parents. Please discuss these options with your transplant coordinator or social worker.
Recommendations for male transplant patients
Male transplant patients might experience difficulty with erections after surgery. This might be caused by a reduction of blood flow to the penis, or it might be a result of the transplant medicines. In most cases, this situation can be corrected.
If impotence becomes a problem for you, please feel free to discuss any concerns with your doctor or transplant coordinator. If they can't help, they'll recommend specialists who can.
Lung Transplant Resources
General Transplant Resources
- Cleveland Clinic Transplant Center https://my.clevelandclinic.org/departments/transplant
- United Network for Organ Sharing (UNOS) https://unos.org/
- American Transplant Foundation https://www.americantransplantfoundation.org/
- National Foundation for Transplants https://transplants.org/
- American Society of Transplant Surgeons https://asts.org/
- Children’s Organ Transplant Association, Inc. https://cota.org/
- Help Hope Live https://helphopelive.org/
- Transplant Recipients International Organization (TRIO) https://www.trioweb.org/