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A lung transplant is a surgical procedure to replace a lung that has failed. For some people with chronic obstructive pulmonary disease (COPD), a lung transplant may help if medications and other therapies are no longer able to help them breathe effectively.

While a lung transplant can be a life-saving surgery, this invasive procedure has a number of risks, including organ rejection. There’s also a lengthy recovery period.

But with proper medication and close monitoring by a physician, a lung transplant can be a life-changing procedure for someone struggling with the most severe effects of COPD.

The term COPD refers to a group of respiratory conditions, like emphysema and chronic bronchitis, that restrict the lungs’ ability to expel air.

Breathing becomes difficult, and symptoms like coughing and congestion become chronic problems. In the early stages of COPD, bronchodilators and other medications can often help ease symptoms and make breathing easier.

When you reach stage 4 COPD, breathing can become difficult to the point that a lung transplant or lung volume reduction surgery may be the only way to improve respiration.

Without surgery, a person with COPD can develop heart disease, lung cancer, and other health problems. According to the American Lung Association, COPD can lead to “long-term disability and early death.”

The University of California at San Francisco suggests the following criteria for people lung transplant eligibility:

  • biological age of 60 or younger for bilateral lung transplantation (both lungs), and 65 or younger for a single-lung transplant
  • estimated survival of just 18 to 24 months
  • no other serious health conditions
  • history of good medication adherence
  • emotional stability and an understanding of what life may be like with a lung transplant
  • robust social support network

Physiological age matters

If you’re younger than 60, but your physical condition is that of a much older person, you may not be eligible for a lung transplant to treat COPD. This is due to the increased risks associated with a physiological age above 60.

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A lung transplantation is a complicated operation that can lead to minor and life-threatening complications.

Among the risks associated with the procedure are:

  • bleeding
  • blocked airways
  • infection
  • blocked blood vessels in the transplanted lung
  • pulmonary edema (fluid buildup in the new lung)
  • pulmonary embolism (blood clot in the lungs)
  • organ rejection

One reasonable alternative to a lung transplant is a lung volume reduction surgery (LVRS). This involves the removal of the most damaged portion of the lung. The removal of damaged lung tissue allows healthy lung tissue to function more efficiently.

A 2018 report in the European Respiratory Journal notes that LVRS is a viable option for people with serious COPD that can reduce mortality and improve quality of life.

Before you have a lung transplant, it’s vital that you quit smoking if you haven’t already. You must be nicotine-free before you can be considered as a transplant recipient.

Once you’re approved as a lung transplant recipient, you’ll be in touch with a transplant coordinator at the hospital where the procedure will be done. When you’re notified that a donor lung or lungs are available, you’ll schedule a day and time for the surgery.

Prior to arriving at the hospital, you should:

  • not drink or eat anything
  • gather your medications, insurance information, and any other documents the facility requires
  • pack a cell phone and charger, as you’ll be in the hospital for at least a few weeks
  • make arrangements for help at home after your surgery

At the hospital, you’ll sign a consent form and talk with the anesthesiologist. You may or may not meet with the surgeon prior to the transplant depending on the surgeon’s availability.

A single-lung transplant takes about 6 to 8 hours, while a bilateral transplant could take 8 to 12 hours. You can then expect to remain in the hospital for up to a month.

Once you’ve been given anesthesia that will allow you to sleep during surgery, the following steps will be taken:

  • A breathing tube attached to a ventilator will be placed down your throat. You may be placed on a cardiopulmonary bypass machine (heart-lung machine) if your COPD prevents healthy blood flow to your other organs.
  • A urinary catheter will be placed into your bladder to collect urine during the procedure.
  • The surgeon will open your chest. If you’re receiving one lung, the incision will be made on the side with the lung that’s being removed. If you’re receiving two lungs, the incision will be made horizontally across the chest under the breasts.
  • The diseased lung or lungs are removed and the donor’s lungs are put in their place.
  • The blood vessels and airways that supply the lung or lungs are reattached.
  • The incision is closed.

Immediately after surgery, you’ll be monitored to make sure your body is accepting the new lung and that any side effects or complications can be spotted early.

You’ll also be given anti-rejection medications and admitted to the ICU for close monitoring until you can breathe on your own without the assistance of a ventilator. This may take several hours or several days.

Anti-rejection drugs help prevent lung rejection. It’s not uncommon for the body to reject any organ transplant, but medications can help suppress the body’s immune response temporarily to allow the body to accept the transplanted organ. You’ll also be given pain-relieving medication.

In the days after surgery, you’ll begin pulmonary rehabilitation. This will include breathing exercises and physical therapy. Getting you moving as soon as possible will also help prevent blood clot formation.

After you’re discharged from the hospital, you’ll have regular appointments with your doctor or with someone at the post-transplant clinic at the hospital. In some cases, these appointments are 2-day visits where your respiratory health and overall health are screened.

You may not be able to climb stairs or engage in other strenuous activities for several weeks after discharge. Be sure to make arrangements with work and at home to accommodate a slow but steady recovery.

It’s important that you be close to a transplant center in case there are complications, like an infection. Some symptoms to watch out for include:

  • fever
  • chills
  • swelling or fluid oozing from the incision site

Shortness of breath, coughing, or other breathing troubles that don’t get better over time — especially after a few months of recovery and pulmonary rehabilitation — should be evaluated by a doctor as soon as possible.

Other reported survival rates for lung transplants for COPD averages 5 to 6 years. A 2020 study in Transplantation Proceedings found that end-stage COPD patients who underwent lung transplantation survived longer than those who didn’t have the surgery.

In addition to living longer, those who had lung transplants experienced better respiratory efficiency.

The previously mentioned study, as well as research published in 2010 in the American Journal of Respiratory and Critical Care Medicine, noted that bilateral lung transplantation has greater survival benefits than single-lung transplants.

A lung transplant isn’t a permanent cure for COPD, but it may help you control your symptoms and live longer. The surgery can be an effective means of improving survival — some research showing that more than half of COPD patients who undergo a lung transplant survive at least 5 years.

Keep in mind that COPD is a chronic condition that will require a healthy lifestyle, ongoing medication use, and close monitoring by medical professionals for the rest of your life.

Even though there’s no cure for COPD, a lung transplant can make life easier for a lot of people who might otherwise never take a deep, rejuvenating breath again.