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Lung Transplant Process

Lung Transplant Process

The purpose of this video is to give you information

about the process of having a lung transplant.

Transplantation is a team effort. We are your team and you are the most important member!

It is important that you share all of this information with your family and others supporting

you in this journey. You must have a dedicated support person to accompany you throughout

the entire process of having a lung transplant. This video will help you to understand the

process of having a transplant and the significant changes that are required to your lifestyle.

The transplant assessment process Your lung transplant journey starts with a

referral from your respirologist. If the referral is accepted, you will meet with a lung transplant

respirologist. At this appointment, you will learn if lung transplant might be a good treatment

option for you. After this appointment, the lung transplant respirologist will ask the

team to plan a transplant assessment. This process helps to determine if transplantation

is the right treatment for you and ensures that it is as safe as possible for you to

have a transplant. The assessment process will involve coming to the hospital to have

a number of tests, and meeting with key members of your team. Having a lung transplant is

a big decision. You need to understand the benefits, the risks, and our program requirements.

The assessment process will give you and our team the information to make an informed decision

about having a lung transplant.

Once your assessment is complete, the transplant team will meet to review your results. This

assessment process can take up to 8 weeks. Your transplant coordinator will call you

to discuss the results of your assessment. If a transplant is recommended, the choice

to proceed is up to you. We will support you whether you go forward with a transplant

or not.

Waiting on our list If you decide to have a lung transplant you

will meet with a lung transplant surgeon and your transplant coordinator to discuss your

surgery and to sign surgical consent forms. At this point you are officially placed on

the lung transplant waiting list.

The time that you wait for your lung transplant is unpredictable because you have to be matched

to a suitable donor. Our surgeons use several factors to match donors with patients on the

waiting list. Two of the most important factors are: Blood type and lung size

Because of this, there is no “TOP” spot on the waiting list.

While you are waiting for your lung transplant there are three main goals:

First, maintain your health and improve your strength. Our physiotherapy program will help

you achieve this goal. The physiotherapists will also work with the doctors to ensure

your oxygen needs are met.  Second, identify and manage any new and existing

problems that may arise. We will partner with your local healthcare team to manage your

health. You and your support person will attend frequent appointments at our hospital.

Third, continuing to learn about life with a lung transplant through our support and

education groups and by speaking to your transplant team.

Your surgery:

Immediately before transplant, we will do a few last minute tests and you will receive

anti-rejection medications and antibiotics. There is a chance that the surgery will be

cancelled at the last moment as the team is assessing the donor lungs right up to the

moments before the surgery.

In the operating room, you will be given medication to keep you unconscious. Several tubes are

inserted into your body, including an endotracheal tube, which is a breathing tube that extends

from your mouth into the lungs, an intravenous line in your neck, a nasogastric or “NG”

tube that goes into your stomach through your nose, and a urinary catheter that drains urine

freely into a bag.

The surgery itself can take 6 or more hours depending on your condition and whether you

have a double or a single lung transplant. Some people need to have their lung or heart

function supported by machines before, during or after the surgery.

Your chest will be opened between the ribs in the front across the breast bone or at

the side. The diseased lungs will be removed and replaced with the donor lungs one at a

time. The new lung will be connected to the main bronchus, the pulmonary artery, and the

pulmonary vein. After the lung is connected, the surgeons will leave drainage tubes around

the lungs and heart and carefully close the layers of bone, muscle and skin.

After the surgery, you will be taken to the intensive care unit, or ICU. You will remain

there until you can breathe without the help of the ventilator, or breathing machine, and

until your condition is stable. In the ICU, you will be on a monitor that shows your heart

rate, blood pressure and other vital signs to the team at all times. The endotracheal

or “breathing” tube, intravenous, chest tubes, nasogastric tube and urinary catheter

will be removed as your condition improves.

If you still require the ventilator to breathe after about a week, you may need to have a

temporary tracheostomy tube inserted through your neck into your trachea. The tracheostomy

will make you feel more comfortable and help you to get strong enough to breathe without

the ventilator and will make it easier to clear mucus from your lungs. The staff will

be able to suction mucus from your lungs through the endotracheal or tracheostomy tubes. While

on the ventilator you will not be able to talk, but if you are awake enough, you will

be able to communicate by mouthing words, writing or using other devices.

Once you are well enough to leave the ICU, you will be moved to the acute care unit,

or ACU, and then to the regular care unit. Most people stay in hospital for about 10

days to a few weeks after receiving a lung transplant, while others may have a longer

stay.

You will be given anti-rejection and anti-infection medications to ensure that your lungs work

well. You will also receive medications for other conditions that you might have, such

as pain. Pain should improve over time and pain control is a priority because you must

participate in physiotherapy after the transplant to gain strength and avoid other complications.

You will be sitting in the chair and walking as soon as possible after the surgery with

the help of the physiotherapists and nurses.

The team will help to get you home or to a rehabilitation hospital as soon as it is safe.

The team includes doctors, pharmacists, dieticians, speech language pathologists, occupational

therapists, physiotherapists, nurses and social workers.

After discharge from the Hospital:

As you recover from your transplant, we will help you to learn how to monitor your own

health and to understand complications that may occur.

After transplant, you will have weekly clinic visits at the Ambulatory Transplant Clinic

for the first few months and then less frequent visits over time. It is mandatory that your

support person attends all your clinic visits. Before each clinic visit, you must have blood

work, a chest x-ray and a pulmonary function test. Bronchoscopies and CT scans of the chest

will also be done at longer intervals.

You will participate in an exercise program 3 times a week for the first 3 months after

your discharge. The Physiotherapy team will monitor your physical progress and develop

an exercise program with you. Ongoing exercise is recommended after completion of your supervised

program.

Rejection and Infection Two of the most common complications following

transplant are rejection of the lung and infections.

Rejection is common and can happen any time after your transplant. Rejection happens because

your immune system attacks your transplanted lungs. Your immune system sees your new lungs

as invading cells and can damage them. To prevent this, you will take anti-rejection

medications, also called immunosuppression medications. You will need to take these medications

every day for the rest of your life to protect your new lungs.

Despite taking anti-rejection medications, rejection can still occur. It is often reversible

as long as it detected and treated quickly. If rejection is detected your treatment plan

may include additional medications, adjusting your current medications and other treatments.

Unfortunately, immunosuppressive medications also decrease the body’s ability to fight

infection and infections of the lungs are very common.

Your weekly clinic visits will allow the transplant team to monitor for rejection and infection.

You will also need to: Perform home spirometry readings once daily

and keep a record of your readings. Learn the signs and symptoms of rejections

and infections and report any unusual symptoms to your transplant team right away.

The Transplant Program will continue to monitor your health, and will work closely with you

and your support person, your family doctor and your Respirologist for the rest of your

life. Your family doctor will continue to help you to maintain your general health and

well-being. You will be assigned a transplant nurse coordinator and physician who you and

your care providers can communicate with. Your team is there to help you, but it is

important that you play an active role in maintaining your health and keep them informed

about changes.