Lung transplantation, or pulmonary transplantation is a surgical procedure in which a patient’s diseased lungs are partially or totally replaced by lungs which come from a donor. While lung transplants carry certain associated risks, they can also extend life expectancy and enhance the quality of life for end-stage pulmonary patients.
The history of organ transplants began with several attempts that were unsuccessful due to transplant rejection. Animal experimentation by various pioneers, including Vladimir Demikhov and Henry Metras, during the 1940s and 1950s, first demonstrated that the procedure was technically feasible. James Hardy of the University of Mississippi performed the first human lung transplant on June 11, 1963. Following a single-lung transplantation, the patient, identified later as convicted murderer John Richard Russell, survived for 18 days. From 1963 to 1978, multiple attempts at lung transplantation failed because of rejection and problems with anastomotic bronchial healing. It was only after the invention of the heart-lung machine, coupled with the development of immunosuppressive drugs such as cyclosporine, that organs such as the lungs could be transplanted with a reasonable chance of patient recovery.
The first successful transplant surgery involving the lungs was a heart-lung transplant, performed by Dr. Bruce Reitz of Stanford University in 1981 on a woman who had idiopathic pulmonary hypertension.
Patients who are being considered for placement on the organ transplant list undergo extensive medical tests to evaluate their overall health status and suitability for transplant surgery.
- blood typing; the recipient’s blood type must match the donor’s, due to antigens that are present on donated lungs. A mismatch of blood type can lead to a strong response by the immune system and subsequent rejection of the transplanted organs;
- tissue typing; ideally, the lung tissue would also match as closely as possible between the donor and the recipient, but the desire to find a highly compatible donor organ must be balanced against the patient’s immediacy of need;
- Chest X-ray – PA & LAT, to verify the size of the lungs and the chest cavity;
- pulmonary function tests;
- CT Scan (High Resolution Thoracic & Abdominal);
- Bone mineral density scan;
- MUGA (Gated cardiac blood pool scan);
- Cardiac stress test (Dobutamine/Thallium scan);
- ventilation/perfusion (V/Q) scan;
- cardiac catheterization;