Heart-Lung Transplant

Why is this procedure done?

A heart-lung transplant is a surgery to take out a heart and lungs that are diseased. The doctor replaces them with healthy new organs from a human donor. The new heart and lungs most often come from a person who is "brain dead. " � This means the persons organs are still working well, except the brain. This person's organs may only be working because of supportive machines like a respirator or life support. � �
A heart-lung transplant is only done as a last option. You may need a transplant if drugs, surgery, or other devices cannot manage your condition. You may also need a transplant if: � �

Your heart cannot pump blood well enough to supply the whole body
You have very bad heart failure
There is very high pressure in the vessels in the lungs
You have a very bad heart defect or lung illness from birth

Some people are not able to have a heart-lung transplant. Your doctor may not be able to put you on the list if you: � �

Are over 70 years old
Have poor blood flow throughout the body
Have kidney, lung, or liver illness
Are not able to follow long-term care instructions
Are too sick to survive a risky surgery
Are still smoking, drinking alcohol, or using illegal drugs
Have active infections, hepatitis, or HIV
Have chronic illnesses like diabetes or cancer

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What will the results be?

You will have a new healthier heart and lungs. � �

What happens before the procedure?

Your doctor will take your history and do an exam.
Talk to the doctor about all the drugs you are taking. Be sure to include all prescription and over-the-counter (OTC) drugs, and herbal supplements. Tell the doctor about any drug allergy. Bring a list of drugs you take with you.
Tell your doctor about any bleeding problems. Be sure to tell your doctor if you are taking any drugs that may cause bleeding. Some of these are Coumadin � �, ibuprofen, Aleve � � (naproxen), or aspirin. Certain vitamins and herbs, such as garlic and fish oil, may also add to the risk for bleeding. You may need to stop these drugs as well. Talk to your doctor about them.
Getting a new heart and lungs may take some time. Your doctor will tell you what to do before your new organs arrive. If you are sick enough, you may have to wait for your heart and lungs in the hospital.
Your doctor will talk with you about your options for a new heart and lungs. To be on the transplant waiting list, your doctor may ask for:
- Blood and tissue samples to make sure your body will accept the new organs
- Skin, blood, urine, and sputum samples to check for any infections
- Liver and kidney tests to look for early signs of any problems. The doctors want to make sure they can handle the stress of surgery.
The doctors will also make sure you are emotionally ready for such a big operation.
You will meet with a financial counselor to help you understand the costs involved with a transplant.
If you qualify, you will be put on the transplant waiting list. Your rank on this list depends on how sick you and your heart and lungs are. The sicker you are, the higher on the list you are. You will need to be available for surgery at any time, day or night. The average time on the waiting list is around 6 to 9 months. Some patients die before a heart or lungs are available.
Your doctor may ask you to take a special scrub bath before going to the hospital. This will lessen the amount of germs on your body.

What happens during the procedure?

Once you are in the operating room, you will be given a drug to make you sleepy. It will also help you stay pain free during the surgery. The staff will put an I.V. in your arm to give you fluids and drugs.
When you are asleep, the doctors put a tube in your mouth to help you breathe. They also put another small tube in your nose. This one goes down to your stomach to drain out any food or fluid that might come out during surgery. You will have a tube in your bladder to drain urine.
Your doctor will make a cut on the skin and bone of the chest. Your doctor will place tubes into the vessels going into and out of your heart and your blood will go to a heart-lung machine. This machine will act as your temporary heart and lungs while your doctors operate. After hooking you to a heart-lung machine, your doctor will stop your heart from pumping. Your doctor will take out your old heart and lungs. The new ones will be put in place.
Your doctor will stitch your new heart, lungs, and blood vessels together. Your doctor will make the new heart start and you will be taken off the heart-lung machine.
Your doctor will close the bone and skin of your chest with stitches or staples. Your doctor will cover the wound with clean bandages.
The procedure takes 6 to 12 hours.

What happens after the procedure?

You will go to the Intensive Care Unit. The staff will monitor your breathing, heartbeat, and blood pressure. You may have other tubes or lines around your incision that help the doctor to watch your condition.
A breathing machine will help you breathe for a few days. The staff will take out your breathing tube when you are awake and strong enough to breathe. You may have a sore throat afterwards. You will have chest tubes that will drain fluids from around your heart and lungs.
Your doctor will perform frequent biopsies to make sure your body is not rejecting your heart and lungs after the surgery.
Within a day or two, you will get out of bed and sit on a chair. The staff will help you as you begin to walk around. You need to cough and do deep breathing exercises to help keep your lungs clear. You will get drugs through your I.V. to help with your pain.
You will stay in the hospital for 1 to 3 weeks for recovery.

What care is needed at home?

Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says. This way you will know what you need to do.
Keep your wound clean and dry.
You will take drugs your body needs to accept the transplanted heart. Take all of your drugs as ordered by your doctor.
Wear a mask as much as possible to protect yourself from infections.
Avoid contact with people who are sick.
Practice proper hygiene. Wash your hands with soap and water.
Talk to your doctor about how to care for your cut site. Ask your doctor about:
- When you should change your bandages.
- When you may take a bath or shower.
- If you need to be careful with lifting things over 10 pounds.
- When you may go back to your normal activities like work, driving, or sex.
Be sure to wash your hands before touching your wound or dressing.
Weigh yourself each day. Tell your doctor if you gain more than 2 to 3 pounds in 1 day.

What follow-up care is needed?

Your condition needs close monitoring. Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits.
You will need blood work done regularly for the rest of your life. This is to check your drug levels to prevent rejection of your transplanted heart and lung.
Your doctor will tell you if you need other tests. You may need regular chest x-rays and biopsies. You will also need to have regular heart catheterizations to check your heart.
If you have stitches or staples, you will need to have them taken out. Your doctor will often want to do this in 1 to 2 weeks.
Your doctor will tell you if you need to see a specialist like a cardiologist or rehab specialist for your new heart and lungs rehab. This will include counseling and exercise training to help you and your new heart and lungs recover.
Recovery may take up to 6 months. You will need to stay near the hospital for the first 3 months, in case you need to return to the hospital and for weekly checkups. The better you do, the less you visit.

What lifestyle changes are needed?

Rest is important. Your activity level will depend on your procedure or treatment. Talk to your doctor about the right amount of activity for you. Ask your doctor when you can go back to your normal activities.
Exercising can help lower fatigue. Your doctor may suggest physical therapy for strengthening.
Do light activities. Start with walking and light exercises.
Avoid being around smoke.
Do not smoke. Avoid drinking beer, wine, and mixed drinks (alcohol).
You will be taking drugs all your life. Learn to keep a journal of your drugs to monitor your intake. Get a refill before your supply runs out.
The drugs you are going to take are keeping your new heart and lungs healthy and preventing your body from rejecting it.
These drugs will also make your immune system low so you need to stay away from crowded places and from people who may have an ongoing infection.

What problems could happen?

Bleeding
Infection
Rejection of the new organs
Cancer
Abnormal heartbeat
Kidney failure
Blood clots in the legs and lungs
Liver problems

Where can I learn more?

American Heart Association � �
http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/CareTreatmentforCongenitalHeartDefects/Heart-Transplant_UCM_307731_Article.jsp � �
National Heart Lung and Blood Institute � �
http://www.nhlbi.nih.gov/health/health-topics/topics/ht/ � �
http://www.nhlbi.nih.gov/health/health-topics/topics/lungtxp/ � �
NHS Choices � �
http://www.nhs.uk/conditions/Heart-lung-transplant/Pages/Introduction.aspx � �

Consumer Information Use and Disclaimer

This information is not specific medical advice and does not replace information you receive from your health care provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or life-style choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care providers advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you. � �

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