Lung Transplant Program

Lung transplantation can be an option for people with end-stage lung disease. The following lung diseases may require lung transplant:

• Emphysema
• Cystic fibrosis
• Pulmonary fibrosis
• Pulmonary hypertension
• Sarcoidosis
• Scleroderma

Our transplant team evaluates patients on a case-by-case basis and focuses on a patient's physiologic age (functional age) and overall health for determination of candidacy. Older patients (65 years old) are still considered for lung transplantation after careful consideration of concomitant medical problems. The maximum age for lung transplant is 75 years old.

Patients with cystic fibrosis whose lung disease has progressed are referred for lung transplantation. Double lung transplantation is required and can improve a patient’s length and quality of life. Patients transplanted for cystic fibrosis have some of the longest predicted survival times after lung transplantation.

A lung transplant is an option for selected patients with severe COPD. During the evaluation process, the lung transplant team will determine if a single or double lung transplant is suitable for the candidate.

Following a physician referral to Baylor University Medical Center for lung disease treatment in Dallas, a patient will undergo a series of tests and counseling to determine if he or she is a candidate for a lung transplant. A patient will have extensive medical testing of the heart, lungs and gastrointestinal system. The tests are performed at Baylor University Medical Center. A patient will be counseled extensively about the process of transplantation and what to expect from lung function and quality of life after transplant. A patient also will meet with transplant pulmonologists, surgeons and cardiologists on the medical staff, along with nutritionists, social workers, financial counselors and physical therapists, among others.

The Lung Transplant Selection Committee will review the results to evaluate if a patient meets the lung transplant requirements. If so, a patient will be approved and placed on the list for transplant. Once on the waiting list, a patient will be assigned a standard Lung Allocation Score (LAS). Lungs are allocated to recipients according to the lung allocation score, blood type and geographic matching between donor and recipient.

The duration a patient may wait for a lung transplant is primarily determined by illness severity—which is calculated as the Lung Allocation Score (LAS). Sicker patients with higher LAS scores are ranked higher on the waitlist. Other factors that influence recipient waitlist time include blood type, antibody profile and size.

Once listed for lung transplantation, you will be followed closely in the transplant clinic, and your score will be updated routinely to determine your sequence on the waitlist.

Once listed, a patient must be in contact and available within a three-hour radius of Baylor University Medical Center in Dallas for a lung donor offer. Our transplant coordinator will provide all instructions. If a patient lives at a farther distance, our transplant coordinator may arrange private air transportation. During the pre-transplant clinic visits, a transplant coordinator will make sure that a patient and his or her family know what to expect immediately before and after surgery. During transplantation, a coordinator will deliver regular updates to the patient’s family.

After receiving the call that donor lungs have been located and the patient arrives at the hospital, he or she will be admitted and prepared for surgery. The patient will have X-rays, blood tests and additional tests. At the same time, members of our transplant team will travel to the donor’s location so the surgeon can examine the donor lungs. It can take several hours to hear whether the donor lungs are acceptable. Sometimes, a transplant is canceled because the surgeon discovered a problem with the donor lungs. We hope this will not happen, but if it does, the patient will not lose his or her place on the waitlist and will likely be called again in the near future.

The cost of lung transplantation is difficult to predict. Costs of medications to prevent infection and rejection continue throughout a patient’s life. It is essential for patients with chronic lung disease to maintain health insurance. Out of pocket expenses vary depending on a patient’s insurance plan. Our team at Baylor University Medical Center in Dallas will work with patients and their insurance providers to help identify and manage these expenses prior to listing for transplantation.

Patients who have undergone lung transplantation report a dramatic improvement in their quality of life. Following recovery from lung surgery, patients usually do not require supplemental oxygen and are able to return to an active lifestyle with considerably more independence in their daily lives. On average, full recovery and physical rehabilitation following lung transplantation surgery takes two to three months.

Immediately after transplant, the patient will be brought to the intensive care unit, where he or she typically stays for a few days. The patient will have many tubes and drains after surgery that will be removed over the first few days after transplant. The patient’s pain will be controlled with intravenous and oral pain medications. Physical therapy will begin immediately after surgery in the intensive care unit. Prior to discharge, the patient will be given a list of medications with an explanation about their importance and instructions on how to take them appropriately. On average, the patient will be in the hospital for two weeks after transplant.

Once leaving the hospital, the patient’s lung transplant team will manage all aspects of his or her medical care for at least the first year after surgery. At these visits, blood tests, radiologic imaging and bronchoscopy, and biopsies are performed routinely. These biopsies are performed on an outpatient basis to evaluate for rejection, a potential response of the patient’s body against the transplanted lung. Blood tests are performed to monitor the levels of anti-rejection medications. After one year, we coordinate the patient’s medical care with his or her primary care physician or pulmonologist. Routine visits to Baylor University Medical Center will continue to be necessary throughout the patient’s life. Visits become more spread out as time from transplant progresses.