Reasons for Double Lung Transplant
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Reasons for Double Lung Transplant

The lungs are the major respiratory system organ; they are divided into lobes. The right lung has three lobes, while the left lung is two lobes. The lungs are covered by a protective membrane known as the pleural membrane. They are housed in the thoracic cavity; the two lungs are separated by a mediastinum and are separated from the abdominal cavity by the diaphragm.

How do the lungs work?

When air is inhaled, it flows into the trachea, branching into the bronchi, which are the passageways of the lung, then into the alveoli, the tiny sacs which are at the end of the bronchi. Blood capillaries surround these sacs. Oxygen passes into these capillaries through the thin membrane of the alveoli and into the bloodstream. The red blood cells take up this oxygen and distribute it throughout the body cells; carbon dioxide is given up by these cells in the same process. This carbon dioxide then travels back up the lungs and is exhaled.

What is a Double Lung Transplant?

A lung transplant is a type of surgery done to replace a diseased or damaged lung with a donated lung; in addition, most lung transplant donors are already dead. For an individual to qualify for a lung transplant, the person must have a very severe lung issue that does not respond to treatment and medication. Essentially they are an effective treatment for any disease condition that has destroyed most, if not all, of the lung function. However, lung transplant surgery is a very risky procedure with a lot of complications.

What is a Double Lung Transplant
Picture courtesy: Gritman Medical Center

What are the types of lung transplants that exist?

The three main types of lung transplant that can be done include:

  • Single lung transplant – this is the removal of only one of the damaged or diseased lungs, replacing it with a donated lung.
  • Double lung transplant – the removal of both lungs of an individual and replacing them with donated lungs
  • Heart-lung transplant – this is the removal of the heart and both lungs of an individual and replacing them with a donated heart and lungs.

What are the reasons for a lung transplant?

Individuals with end-stage lung disease are the likely candidates that can be considered for a lung transplant. The procedure is mostly considered for people that will most likely die without the procedure, with no other options being obtainable. A lung transplant can also be considered in individuals whose lung disease is so terrible that they cannot enjoy life anymore without the procedure. The following are some of the most common disease conditions that cause individuals to undergo lung transplants:

  • Cystic fibrosis
  • Idiopathic pulmonary fibrosis
  • Idiopathic pulmonary arterial hypertension
  • Chronic obstructive pulmonary disease
  • Lung injuries
  • Interstitial lung disease
  • Bronchiectasis
  • COVID-19

Also, lung transplant centers may not consider geriatric patients for a lung transplant. Generally, a good candidate for a lung transplant should possess the following qualities:

  • The individual can bear immunosuppressive therapy
  • The individual does not have lung cancer
  • These individuals have a short life expectancy (1-3 years) without the surgery
  • The individual’s lungs do not respond to treatment or medications
  • The individual has a condition that makes the normal functioning of his lungs difficult

Are lung transplants common?

The procedure is not very common. Also, many people die while waiting for a lung transplant because more people need a lung transplant than there are lung donors.

What is the preparation for a double lung transplant surgery?

What is the preparation for a double lung transplant surgery
Picture courtesy: Wikipedia

The process of evaluation is long and complicated. Many steps are involved before a person qualifies to be on the lung transplant list. The individual is first referred to a regional transplant center by their doctor; the person is met by an array of medical staff who gather information about them and their condition. This may take several visits over weeks or even months. There are a lot of factors that are considered, like the type of lung condition, the psychology of the individual, the financial capabilities of the individual, the person’s family and social support, and if there are other conditions that the person has. Many tests are also carried out on the individual during the evaluation; some of the tests include:

A pap smear is also conducted for women and a prostate examination for men. Doctors would not recommend transplants if any of the following conditions are present:

  • The patient continues smoking
  • Presence of significant heart, liver, or kidney diseases
  • Alcohol or drug abuse
  • Ongoing infections
  • Cancer

After the evaluations, the healthcare team usually meets to discuss the tests and determine if a lung transplant is the best course for the patient. If the patient is cleared for the transplant surgery, they are usually placed on the national lung transplant waiting list. Due to the number of people also on the waiting list, an individual may wait for months or even years before getting the surgery; the person may even die before a donor is available. Some factors, however, may shorten the waiting time for an individual, for example, if the person is seriously ill or if they don’t have issues making matching difficult, like an antibody in their blood that reacts against many donors.

What happens during a double lung transplant?

When compatible donor lungs are available, the transplant candidate will be urgently notified so that they can prepare for the surgery. The surgical team then assesses the deceased donor’s lungs to determine if they are suitable for transplant. If they are, the surgery on the lung recipient begins immediately while the donor’s lungs are in transit to the transplant center. A single or double lung transplant may be done depending on the patient’s lung disease and other factors.

An incision is made on the chest during a lung transplant which varies with the type of transplant to be done – on the side of the chest for a single lung transplant or an incision across the front or on either side of the chest for a double lung transplant. General anesthesia is used throughout the surgery; the diseased lung is removed and then replaced with the donor’s lungs. Blood vessels and airways are then reconnected, and vascularisation is then checked. Fluid is drained from the area, and then the patient is disconnected from the machines that were used to facilitate the surgery. The incisions are then stitched up and bandaged. The procedure is very delicate and requires a lot of time, depending on the number of lungs to be transplanted. A single lung transplant may take up to 4-8 hours, while a double lung transplant may take 6-12 hours.

What are the complications of a double lung transplant?

Surgical risks – this may include anesthesia complications, infection, bleeding, etc.

Transplant rejection – this occurs when the body’s immune system attacks the transplanted lungs. It is common in the first 12 months (acute rejection) after the transplant surgery. This can almost always be reversed with extra immunosuppressive medication. Another form of rejection is called chronic rejection and can occur in some people who are more than three years from their transplant. This form is very difficult to treat and can lead to death or the need for another transplant.

Infection – immunosuppressive medication reduces the body’s immune system’s ability to reject the transplanted lungs. This also affects its ability to fight infection, and there is a higher risk of developing dangerous infections when on immunosuppressive medication.

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