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Lung Transplantation
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What is a lung transplant? |
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A lung transplant is an operation done to remove a diseased lung from a patient and replace it with a healthy one from another person. Lung transplantation may involve a single, double or in combination with other organs.
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Why is a lung transplant recommended? |
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Lung transplantation is a treatment option for children and young adults with end-stage lung disease. Diseases that may require a lung transplant include the following: |
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- Cystic fibrosis (a genetic disorder affecting the lungs and digestive system)
- chronic lung disease, which may be caused by a variety of factors.
- Pulmonary hypertension (increased pressure in the arteries of the lungs).
- Heart disease or heart defects affecting the lungs (may require a heart-lung transplant).
- Pulmonary fibrosis (scarring of the lung).
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Lung transplants can now be performed in all ages - from newborn to adult. Your child's physician will discuss the lung transplant selection criteria with you.
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Lung transplant statistics: |
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According to June 2001 statistics available from the United Network for Organ Sharing (UNOS): |
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- Currently, there are over 3,700 individuals on the waiting list for lung transplants.
- There were 956 total lung transplants performed in 2000.
- The number of transplants has plateau'd over the last few years.
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Where do transplanted organs come from? |
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The majority of lungs that are transplanted come from deceased organ donors. Organ donors are adults or children who have died. Donors can come from any part of the United States. This type of transplant is called a "cadaveric" transplant. In rare cases living adults are able to donate a part of their lung to someone else. This is called a "living-donor" transplant.
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How are transplanted organs allocated? |
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The United Network for Organ Sharing (UNOS) is responsible for transplant organ distribution in the United States. UNOS oversees the allocation of many different types of transplants, including liver, kidney, pancreas, heart, lung and cornea.
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UNOS receives data from hospitals and medical centers throughout the country regarding adults and children who need organ transplants. The medical team that currently follows your child is responsible for sending the data to UNOS and updating them as your child's condition changes.
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Criteria have been developed to ensure that all people on the waiting list are judged fairly as to the severity of their illness and the urgency of receiving a transplant.
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How is a child placed on the waiting list for a new lung? |
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Tests are done to gather information that will help determine how urgent it is that your child is placed on the transplant list, as well as ensure the child receives a donor organ that is a good match. These tests include those to analyze the general health of the body, including the child's heart, lung and kidney function, the child's nutritional status and the presence of infection.
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The diagnostic tests that are performed are extensive, but necessary to understand the complete medical status of your child. The following are some of the other tests that may be performed, although many of the tests are decided on an individual basis: |
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- Blood tests.
- Urine tests.
- Echocardiogram - a procedure that evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor that produce a moving picture of the heart and heart valves.
- Electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias) and detects heart muscle damage.
- Sputum culture - a diagnostic test performed on the material that is coughed up from the lungs and into the mouth. A sputum culture is often performed to determine if an infection is present.
- Pulmonary function tests - diagnostic tests that help to measure the lungs' ability to exchange oxygen and carbon dioxide appropriately. The tests are usually performed with special machines that a child must breathe into.
- Chest computed tomography scan of the lungs (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general x-rays.
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The transplant team will consider all information from interviews, your child's medical history, physical examination and diagnostic tests in determining whether your child can be a candidate for lung transplantation.
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The lung transplant team: |
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The group of specialists involved in the care of children who are undergoing a transplant procedure is often referred to as the "transplant team." Each individual works together to provide the best chance for a successful transplant. The lung transplant team consists of:
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- Transplant surgeons - physicians who specialize in transplantation and who will be performing the surgery. The transplant surgeons coordinate all team members. They follow your child before the transplant and continue to follow your child after the transplant and after discharge from the hospital.
- Pulmonologists - physicians who specialize in the function and disease of the lungs. Pulmonologists will help manage your child before and after the surgery.
- Cardiologists.
- Transplant nurse coordinator - a nurse who organizes all aspects of care provided to your child before and after the transplant. The nurse coordinator will provide patient education and coordinate the diagnostic testing and follow-up care.
- Psychologists.
- Social workers - professionals who will provide support to your family and help your family deal with many issues that may arise including lodging and transportation, finances and legal issues. They can also help coordinate alternative means for school, so that your child does not get behind.
- Dietitians - professionals who will help your child meet nutritional needs before and after the transplant. They will work closely with you and your family.
- Physical therapists - professionals who will help your child become strong and independent with movement and endurance after the transplantation.
- Pastoral care - chaplains who provide spiritual care and support.
- Other team members - several other team members will evaluate your child before transplantation and provide follow-up care, as needed. These include, but are not limited to, the following:
- Pharmacists.
- Anesthesiologists.
- Respiratory therapists.
- Hematologists.
- Urologists.
- Nephrologists.
- Infectious disease specialists.
- Lab technicians.
- Child life specialists.
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How long will it take to get a new lung? |
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There is no definite answer to this question. It may take one to two years on the waiting list before a suitable donor lung is available. During this time, your child will have close follow-up with physicians and the transplant team. Various support groups are also available to assist you during this waiting time.
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How are we notified when a lung is available? |
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Each transplant team has their own specific guidelines regarding waiting on the transplant list and being notified when a donor organ is available. In most instances, you will be notified by phone or pager that an organ is available. You will be told to come to the hospital immediately so your child can be prepared for the transplant.
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Lung transplant follow-up: |
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Your child will have very close follow-up with the transplant team after leaving the hospital. This will allow for close monitoring of your child and the function of the transplanted lung.
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Children who have received a lung transplant will need life-long follow-up with physicians who are specialized in transplant medicine.
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Every child is unique and every transplant is different. Results continually improve as physicians and scientists learn more about how the body deals with transplanted organs and search for ways to improve transplantation.
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