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The Multi Organ Transplant Program has pioneered the field of lung transplantation. In 1983, the world's first successful single lung transplant was performed, with the world's first successful double lung transplant to follow shortly thereafter in 1986. Two years later, in 1988, double lung transplantation would be introduced as a treatment option for patients with cystic fibrosis. Today, the program performs over 60 lung transplants per year and is poised to introduce Ontario's first living donor lung transplant program. Indications The causes of end-stage lung diseases vary. Patients under consideration for single and double lung transplant present with a variety of lung diseases. The following list outlines some of the lung diseases that may be referred for lung transplantation. 1. Chronic Obstructive Pulmonary Disease (COPD)
Assessment Pre-transplant evaluation consists of a variety of medical tests and interviews with members of the transplant team. This process is essential in determining a patient's suitability for lung transplant. During the evaluation process the potential candidates and their family will be provided with information to assist them in making informed decisions about the operation and post-operative period. The patient and their family are encouraged to ask questions of the team members and meet the candidates awaiting transplant as well as those having received a lung transplant. Patients with chronic infections (e.g., cystic fibrosis) are generally treated by double lung transplant. Patients with emphysema or interstitial lung diseases may be managed by either a single or double lung transplant. The workup process typically involves the following tests, but may require additional testing if other health issues are of concern:
The Transplant Team Members who consult on lung transplant evaluation are:
Waiting List There are presently over 60 patients on the waiting list for lung transplant within our program. The waiting period for a donor varies in length because the donor pool is limited and the selection criteria for a matching donor are strict. Patients can expect to wait a minimum of a couple of days, up to 24 months, but most patients are transplanted within 12-18 months. Once accepted as a lung transplant candidate, patients must live within the Toronto area to facilitate access to the transplant team for ongoing monitoring, support and education, as well as ready availability when called for transplant. Surgery Lung transplant surgery may last anywhere from 5 to 10 hours. The following are brief descriptions of the surgical process for both single and double lung transplant procedures. Single Lung Transplant Patients first undergo a thoracotomy to remove the diseased lung and prepare the site for transplantation of the new lung as the donor lung arrives in the operating room. There will be 3 anastomoses to attach the new lung:
Double Lung Transplant Double lung transplant is performed through a transverse sternotomy incision. Double lung transplant involves replacing each lung separately. As the donor lungs arrive in the operating room, the recipient's first lung is removed. Patients may undergo some form of cardiopulmonary bypass during the procedure. After removal of the first lung, one donor lung will be attached. There will 3 anastomoses as in single lung transplant. At this point, blood flow is restored to this first new lung. The recipient's second diseased lung is then removed. The second new lung is attached as with the first one. Once the second lung is completely connected, blood flow is restored to it. After surgery, patients recover and spend at least 1 to 2 days in the intensive care unit. Recovery Lung transplant recipients can expect to be in the hospital for approximately 2-3 weeks after surgery. After the transplant procedure, patients are usually ventilated and monitored hemodynamically in the intensive care unit. Once stabilized and extubated, patients are then transferred to the Multi Organ Transplant Unit. Patient care following transplantation focuses on:
Discharge & Follow-up Discharge planning begins well in advance and patients meet with a social worker during their initial assessment to addressing these issues early. Many pre-transplant patients are required to have a support person living with them. Patients most commonly continue living in Toronto until their transplant has stabilized. The program's Patient Resource Coordinator assists in assessing patients' readiness for discharge and ensuring patient teaching is complete. Patients will return to the Ambulatory Care regularly after the initial postoperative period, with the frequency of clinic visits reduced as the patient's condition permits. During clinic appointments, patients are seen by their Transplant Coordinator, Transplant Physician, and Primary Care Nurse Practitioner. Communication with the patient's family physician and other specialists is an important component of follow-up care. Patients keep in contact with their transplant team through our patient voicemail system, Easy Call. The Multi Organ Transplant Program's team approach ensures that patients receive comprehensive follow-up care after transplantation and throughout their lives post-transplant.
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