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

heart The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...

and

lungs The lungs are the primary organs of the respiratory system in many animals, including humans. In mammals and most other tetrapods, two lungs are located near the backbone on either side of the heart. Their function in the respiratory syste ...

in a single operation. Due to a shortage of suitable donors and because 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.

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) or heart-lung machine, also called the pump or CPB pump, is a machine that temporarily takes over the function of the heart and lungs during open-heart surgery by maintaining the circulation of blood and oxygen throu ...

, 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 or myocardium) is one of three types of vertebrate muscle tissues, the others being skeletal muscle and smooth muscle. It is an involuntary, striated muscle that constitutes the main tissue of the wall o ...

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.

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 Nonprofit organization, non-profit scientific and educational organization that administers the only Organ Procurement and Transplantation Network (OPTN) in the United States, established () by th ...

(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 Pulmonary hypertension (PH or PHTN) is a condition of increased blood pressure in the pulmonary artery, arteries of the lungs. Symptoms include dypsnea, shortness of breath, Syncope (medicine), fainting, tiredness, chest pain, pedal edema, swell ...

(20%); *

Cystic fibrosis Cystic fibrosis (CF) is a genetic disorder inherited in an autosomal recessive manner that impairs the normal clearance of Sputum, mucus from the lungs, which facilitates the colonization and infection of the lungs by bacteria, notably ''Staphy ...

(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 The HIV, human immunodeficiency virus (HIV) is a retrovirus that attacks the immune system. Without treatment, it can lead to a spectrum of conditions including acquired immunodeficiency syndrome (AIDS). It is a Preventive healthcare, pr ...

Diabetes Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...

Hepatitis Hepatitis is inflammation of the liver parenchyma, 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), Anorexia (symptom), poor appetite ...

); * 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 the activity of the immune system. Classification Immunosuppressive drugs can be classified ...

drugs.

Post-operation

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

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

, 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 pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...

to prevent infection as the anti-rejection drugs 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 term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...

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.

History

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

Stanford Leland Stanford Junior University, commonly referred to as Stanford University, is a private research university in Stanford, California, United States. It was founded in 1885 by railroad magnate Leland Stanford (the eighth governor of and th ...

in the mid-1960s. Shumway conducted the first adult heart transplant in the US in 1968. The first successful heart transplant was performed in South Africa in 1967. The first successful heart–lung transplant was performed at Stanford in the United States, by Bruce Reitz on Mary Gohlke in 1981.

Magdi Yacoub Sir Magdi Habib Yacoub ( ; born 16 November 1935) is an Egyptian-British retired professor of cardiothoracic surgery at Imperial College London, best known for his early work in repairing heart valves with surgeon Donald Ross, adapting the ...

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

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 Hea ...

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

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 Lobes of t ...

Lung