Heart-Lung Transplant

What Is It?

A heart-lung transplant is surgery for someone with life-threatening respiratory and cardiac problems. Surgeons remove the damaged heart and lungs and replace them with a healthy heart and lungs from a person who has died. The person receiving the new heart and lungs (the recipient) is someone with a high chance of dying within one to two years without a transplant. The person providing the healthy heart and lungs (the donor) is someone who is brain dead, but still on life-support machinery.

Currently, surgeons perform fewer than 100 heart-lung transplants each year in the United States. This unusually small number is largely the result of a shortage of suitable donors. The requirements for heart-lung donation are stricter than those for heart donation alone. Only 10 percent to 20 percent of people who are suitable heart donors also fit the criteria for donating both heart and lungs.

Heart-lung donors are usually younger than 50 years old, have no history of heart or lung problems and are free from infectious diseases. Donor and recipient should be about the same height and weight so that their lungs are about the same size. The donor's chest X-ray must be normal, and the donor's lungs must have normal elasticity. The blood types of the recipient and donor also must be a good match. At any time, about 250 patients are on the national waiting list to receive a heart-lung transplant. About 40 of these patients will die within 12 months because suitable organs will not be found. In most cases, potential donor organs are located through an organization called the United Network for Organ Sharing (UNOS).

What It's Used For

A heart-lung transplant treats irreversible, life-threatening lung disease in someone who also has significant heart damage. Because other treatment options have failed, the person has a high risk of dying within the next 12 to 24 months, even with oxygen and medication. Currently in the United States, surgeons perform heart-lung transplants for the following reasons:

• Congenital problems affecting the heart and lungs, especially Eisenmenger's syndrome (48 percent of all U.S. heart-lung transplants in 1997)
• Primary pulmonary hypertension, an illness in which increased pressure in the lung's blood vessels affects blood flow and oxygen exchange (about 20 percent of all heart-lung transplants)
• Cystic fibrosis (about 2 percent of heart-lung transplants)
• A second transplant after the first heart-lung transplant fails (about 4 percent)
• Other causes (about 26 percent), including emphysema, sarcoidosis, eosinophilic granulomatosis (a disease in which blood cells cause inflammation and damage in the lungs and elsewhere), asbestosis, and idiopathic pulmonary fibrosis (a disease in which the lung becomes scarred and stiff for unknown reasons)