Patients who come to the Center for Thoracic Transplantation at St. Joseph's Hospital and Medical Center receive a thorough evaluation by leading experts in lung disease.
Evaluation
Patients have to be tobacco and substance-free for six months in order to be evaluated. Patients should be ambulatory or have rehabilitation potential. An evaluation of extensive testing will be completed and may take two to three days. Evaluation is usually done on an outpatient basis, but for severely ill or hospitalized patients, inpatient evaluation can be done.
Listing
After undergoing an evaluation, each patient's case is discussed at a multidisciplinary conference. If the patient is determined to be an appropriate candidate for lung transplantation, they are placed on the lung transplant wait list with the United Network for Organ Sharing.
Getting the Call for a Transplant
Once a patient is accepted as a candidate for transplant they can be called to come to the hospital at any time. Patients receive a call from the hospital when suitable organs are available for them. The patient must arrive at St. Joseph's promptly. Upon arrival, the anesthesia team evaluates the patient, and pre-operative tests such as EKG, chest X-ray, blood work and urine sample are done prior to proceeding to transplant. Occasionally, donor lungs initially thought to be suitable turn out not to be optimal for transplant, and patients may have to return home after arriving at the hospital. This is called a "dry run". But, more often, the patient proceeds to transplant surgery.
What to Expect with Surgery
The lung transplant surgery takes from four to six hours, depending on medical conditions. After surgery the patient goes to the Cardiac Surgical Intensive Care Unit for 24 to 48 hours. Patients are on a respirator and have chest tubes, usually for a few days. From the CICU, the patient is transferred to the thoracic transplant nursing unit, depending on their condition. Bronchoscopy is done frequently to evaluate the airways. After removal from the respirator, patients are started on an intense regimen of rehabilitation and on immunosuppressive medications. The expected length of stay for an uncomplicated lung transplant is three to four weeks.
After the Transplant
The transplant team follows transplant recipients throughout their recovery. Once patient’s chest tubes are removed, and they are ambulatory and familiar with their medications, they are discharged from the hospital. After discharge, patients are followed in the lung transplant clinic twice weekly for the first month and then less frequently depending on their clinical course. Patients have blood work, pulmonary function tests and chest X-rays on each clinic visit. They are required to participate in a rehabilitation program after the surgery.
Patients also undergo bronchoscopy frequently post-transplant to rule out rejection. Patients are instructed to report any fever, cough, shortness of breath, chest pain, abdominal pain or any new symptoms promptly to their nurse coordinator.
For patients who live more than driving distance away from St. Joseph's, prior arrangements need to be made to stay near the hospital for the first few months after surgery. Travel and lodging needs are determined prior to listing for transplant. Our social worker can help families with these arrangements.
