A lung transplant is a surgical procedure performed to remove one or both diseased lungs from a patient and replace it with a healthy one from another person. The majority of lungs that are transplanted come from deceased organ donors. This type of transplant is called a cadaveric transplant. Healthy, nonsmoking adults who make a good match may be able to donate a part (a lobe) of one of their lungs. This type of transplant is called a living transplant. Individuals who donate a part of a lung can live healthy lives with the remaining lung tissue.
Various types of lung transplant procedures include single lung (transplantation of one lung); double lung, bilateral sequential, or bilateral single (transplantation of two lungs); and heart-lung transplants. The type of procedure performed depends on the condition of the recipient.
Lung transplantation is a treatment option for children and young adults with severe cystic fibrosis (CF), with end-stage lung disease, and other chronic lung diseases. CF is the most common underlying disease that may require a lung transplant among children, adolescents, and young adults. Some of the other diseases that may require a lung transplant among this population include the following:
Lung transplants can now be performed in all ages--from newborn to adult. Your child's doctor will discuss the lung transplant selection criteria with you.
The majority of lungs that are transplanted come from deceased organ donors. Organ donors are adults or children who have become critically ill and will not live as a result of their illness. If the donor is an adult, he or she may have agreed to be an organ donor before becoming ill. Parents or spouses can also agree to donate a relative's organs. Donors can come from any part of the United States. This type of transplant is called a cadaveric transplant.
The Organ Procurement and Transplant Network (OPTN) is responsible for transplant organ distribution in the United States. OPTN oversees the allocation of many different types of transplants, including liver, kidney, pancreas, heart, lung, and cornea.
OPTN receives data from hospitals and medical centers throughout the country regarding adults and children who need organ transplants. The medical team that currently follows your child is responsible for sending the data to OPTN and updating them as your child's condition changes.
Criteria have been developed to ensure that all people on the waiting list are judged fairly as to the severity of their illness and the urgency of receiving a transplant. Once OPTN receives the data from local hospitals, people waiting for a lung transplant are placed on a waiting list and given a "status" code. The people in most urgent need of a transplant are placed highest on the status list and are given first priority when a donor lung becomes available.
When a donor lung becomes available, a computer searches all the people on the waiting list for a lung and sets aside those who are not good matches for the available lung. A new list is made from the remaining candidates. The person at the top of the specialized list is considered for the transplant. If he or she is not a good candidate, for whatever reason, the next person is considered, and so forth. Some reasons that people lower on the list might be considered before a person at the top include the size of the donor organ and the geographic distance between the donor and the recipient.
An extensive evaluation must be completed before your child can be placed on the transplant list. Testing includes:
Tests are done to gather information that will help you ensure your child receives a donor organ that is a good match. These tests include those to analyze the general health of the body, including the child's heart, lung, and kidney function, the child's nutritional status, and the presence of infection. Blood tests will help improve the chances that the donor organ will not be rejected. These tests may include:
The diagnostic tests that are performed are extensive, but necessary to understand the complete medical status of your child. The following are some of the other tests that may be performed, although many of the tests are decided on an individual basis:
The transplant team will consider all information from interviews, your child's medical history, physical examination, and diagnostic tests in determining whether your child can be a candidate for lung transplantation. After your child has been accepted to have a lung transplant, your child will be placed on the Organ Procurement and Transplant Network (OPTN) list..
The group of specialists involved in the care of children who are undergoing a transplant procedure is often referred to as the transplant team. Each individual works together to provide the best chance for a successful transplant. The lung transplant team consists of:
There is no definite answer to this question. It may take one to two years on the waiting list before a suitable donor lung is available. During this time, your child will have close follow-up with his or her doctors and the transplant team. Various support groups are also available to assist you during this waiting time.
Each transplant team has their own specific guidelines regarding waiting on the transplant list and being notified when a donor organ is available. In most instances, you will be notified by phone or pager that an organ is available. You will be told to come to the hospital immediately so your child can be prepared for the transplant.
Once an organ becomes available to your child, you and your child will be immediately called to the hospital. This call can occur at any time, so you should always be prepared to go to the hospital if needed. Once at the hospital, the child will have some more final blood work and tests to confirm the match of the organ.
The child will then go to the operating room. The transplant surgery may require from six to 12 hours, but can vary greatly depending on the type of surgery and on each individual case. Single lung transplantation is performed with the child under general anesthesia. It is not always necessary to have cardiopulmonary bypass (rerouting of the blood through a heart-lung bypass machine) with a single lung transplant.
However, if two separate lungs are transplanted, cardiopulmonary bypass is often necessary. Heart-lung transplants always require the use of cardiopulmonary bypass.
During the surgery, a member of the transplant team will keep you informed on the progress of the transplant.
After the surgery, your child will go to an intensive care unit (ICU) to be monitored closely. The length of time your child will spend in the ICU will vary based on your child's unique condition. After your child is stable, he or she will be sent to the special unit in the hospital that cares for lung transplant patients. Your child will continue to be monitored closely. You will be educated on all aspects of caring for your child during this time. This will include information about medications, activity, follow-up, diet, and any other specific instructions from your transplant team.
Rejection is a normal reaction of the body to a foreign object. When a new lung is placed in a your child's body, the body sees the transplanted organ as a threat and tries to attack it. The immune system makes antibodies to try to destroy the new organ, not realizing that the transplanted lung is beneficial. To allow the organ to successfully live in a new body, medications must be given to trick the immune system into accepting the transplant and not thinking it is a foreign object.
The following are the most common signs and symptoms of rejection. However, each child may experience symptoms differently. Symptoms may include:
Your child's transplant team will instruct you on who to call immediately if any of these symptoms occur.
Medications must be given for the rest of the child's life to fight rejection. Each child is unique, and each transplant team has preferences for different medications.
Because anti-rejection medications affect the immune system, children who receive a transplant will be at higher risk for infections. A balance must be maintained between preventing rejection and making your child very susceptible to infection. Blood tests are performed periodically to measure the amount of medication in the body to ensure your child does not get too much or too little of the medication. White blood cells are also an important indicator of how much medication your child needs.
The risk of infection is especially great in the first few months because higher doses of anti-rejection medicines are given during this time. Your child will most likely need to take medications to prevent other infections from occurring. Some of the infections your child will be especially susceptible to include oral yeast infection (thrush), herpes, and respiratory viruses.
Your child will have very close follow-up with the transplant team after leaving the hospital. This will allow for close monitoring of your child and the function of the transplanted lung. Follow-up visits may include the following:
Children who have received a lung transplant will need lifelong follow-up with doctors who specialize in transplant medicine. Keeping appointments with your child's transplant doctor, as well as maintaining contact with the transplant team when signs and symptoms of rejection occur is vital. Parents (and the recipient, when old enough) are the first line of defense; they must understand and recognize the signs and symptoms of rejection and report them as soon as possible to the transplant team.
Living with a transplant is a lifelong process. Medications must be given that trick the immune system so it will not attack the transplanted organ. Other medications must be given to prevent side effects of the anti-rejection medications, such as infection. Frequent visits to and contact with the transplant team are essential. Knowing the symptoms of organ rejection (and watching for them on a daily basis) is critical. When the child becomes old enough, he or she will need to learn about anti-rejection medications (what they do and the signs of rejection), so he or she can eventually care for himself or herself independently.
Every child is unique and every transplant is different. Results continually improve as doctors and scientists learn more about how the body deals with transplanted organs and search for ways to improve transplantation.
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