A heart–lung transplant is a procedure carried out to replace both

heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide t ...

and

lungs The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of th ...

in a single operation. Due to a shortage of suitable donors and due to the fact that both heart and lung have to be transplanted together, it is a rare procedure; only about a hundred such transplants are performed each year in the United States.

Qualifying conditions

Most candidates for heart–lung transplants have life-threatening damage to both their heart and lungs. In the US, most prospective candidates have between twelve and twenty-four months to live. At any one time, there are about 250 people registered for heart–lung transplantation at the

United Network for Organ Sharing The United Network for Organ Sharing (UNOS) is a non-profit, scientific and educational organization that administers the only Organ Procurement and Transplantation Network (OPTN) in the United States, established () by the U.S. Congress in 1984 ...

(UNOS) in the US, of which around forty will die before a suitable donor is found. Conditions which may necessitate a heart–lung transplant include: * Congenital problems (defects present at birth) affecting the heart and lungs (48%); * Pulmonary hypertension (20%); *

Cystic fibrosis Cystic fibrosis (CF) is a rare genetic disorder that affects mostly the lungs, but also the pancreas, liver, kidneys, and intestine. Long-term issues include difficulty breathing and coughing up mucus as a result of frequent lung infections. O ...

(2%); * A second transplant after the first transplant was rejected or failed to operate satisfactorily (4%). Candidates for a heart–lung transplant are usually required to be: * Under 55 years old; * Have no other medical conditions (e.g.

AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual m ...

Diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...

Hepatitis Hepatitis is inflammation of the liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes (jaundice), poor appetite, vomiting, tiredness, abdominal pa ...

); * Mentally sound; * Capable of following a post-operative regimen of exercise and

immunosuppressant Immunosuppressive drugs, also known as immunosuppressive agents, immunosuppressants and antirejection medications, are drugs that inhibit or prevent activity of the immune system. Classification Immunosuppressive drugs can be classified in ...

drugs.

History

Norman Shumway Norman Edward Shumway (February 9, 1923 – February 10, 2006) was a pioneer of heart surgery at Stanford University. He was the 67th president of the American Association for Thoracic Surgery and the first to perform an adult human to human ...

laid the groundwork for heart lung transplant with his experiments into heart transplant at

Stanford Stanford University, officially Leland Stanford Junior University, is a private research university in Stanford, California. The campus occupies , among the largest in the United States, and enrolls over 17,000 students. Stanford is considere ...

in the mid-1960s. Shumway conducted the first adult heart transplant in the US in 1968. While the first successful heart transplant was performed in South Africa in 196

the first successful heart–lung transplant was performed at Stanford in the United States, by

Bruce Reitz Bruce A. Reitz is an American cardiothoracic surgeon, best known for leading the first combined heart-lung transplantation in 1981 with pioneer heart transplant surgeon Norman Shumway. He obtained an undergraduate degree at Stanford University ( ...

on Mary Gohlke in 198

Magdi Yacoub Sir Magdi Habib Yacoub ( ar, د/مجدى حبيب يعقوب ; born 16 November 1935), is an Egyptian retired professor of cardiothoracic surgery at Imperial College London, best known for his early work in repairing heart valves with surgeon ...

performed the first heart-lung transplant in the United Kingdom in 1983. Australia's first heart-lung transplant was conducted by

Victor Chang Victor Peter Chang, AC (born Chang Yam Him; 21 November 19364 July 1991), was a Chinese-born Australian cardiac surgeon and a pioneer of modern heart transplantation in Australia. His sudden murder in 1991 stunned Australia, and is considered ...

St Vincent's Hospital, Sydney St Vincent's Hospital, Sydney is a leading tertiary referral hospital and research facility located in Darlinghurst, Sydney. Though funded and integrated into the New South Wales state public health system, it is operated by St Vincent's Heal ...

in 1986. Iran's first heart-lung transplant was performed in Tehran in 2002.

Procedure

The patient is anesthetised. When the donor organs arrive, they are checked for fitness; if any organs show signs of damage, they are discarded and the operation cancelled. Once suitable donor organs are present, the surgeon makes an incision starting above and finishing below the sternum, cutting all the way to the bone. The skin edges are retracted to expose the sternum. Using a bone saw, the sternum is cut down the middle. Rib spreaders are inserted in the cut, and spread the ribs to give access to the heart and lungs of the patient. The patient is connected to a

heart–lung machine Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a ...

, which circulates and oxygenates blood. The surgeon removes the failing heart and lungs. Most surgeons endeavour to cut blood vessels as close as possible to the heart to leave room for trimming, especially if the donor heart is of a different size than the original organ. The donor heart and lungs are positioned and sewn into place. As the donor organs warm up to body temperature, the lungs begin to inflate. The heart may fibrillate at first – this occurs because the

cardiac muscle Cardiac muscle (also called heart muscle, myocardium, cardiomyocytes and cardiac myocytes) is one of three types of vertebrate muscle tissues, with the other two being skeletal muscle and smooth muscle. It is an involuntary, striated muscle th ...

fibres are not contracting synchronously. Internal paddles can be used to apply a small electric shock to the heart to restore proper rhythm. Once the donor organs are functioning normally, the heart–lung machine is withdrawn, and the chest is closed.

Post-operation

Most patients spend several days in intensive care after the operation. If there are no complications (e.g.

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

, rejection), some are able to return home after just two weeks in hospital. Patients will be given anti-rejection drugs, and

antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...

to prevent infection, this weakens the immune system. A schedule of frequent follow up visits is necessary.

Statistics

The success rate of heart–lung transplants has improved significantly in recent years. The British

National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...

states that the survival rate is now around 85%, one year after the transplant was performed. In 2004, there were only 39 heart–lung transplants performed in the entire United States and only 75 worldwide. By comparison, in that same year there were 2,016 heart and 1,173 lung transplants.Heart–lung transplant
at Mount Sinai Hospital

References

External links

National Heart, Lung and Blood Institute (NHLBI)

Photograph of first successful heart–lung transplant
{{DEFAULTSORT:Heart-Lung Transplant Organ transplantation Cardiac surgery Pulmonary thoracic surgery

Lung Transplant Lung transplantation, or pulmonary transplantation, is a surgical procedure in which one or both lungs are replaced by lungs from a donor. Donor lungs can be retrieved from a living or deceased donor. A living donor can only donate one lung lobe. ...

Lung