Preparation

If a lung transplant is thought to be an option for you, you'll be referred for a transplant assessment.

There are a number of specialist centres that carry out lung transplants in England. They are:

• Freeman Hospital , Newcastle
• Papworth Hospital , Cambridge
• Harefield Hospital , London
• Queen Elizabeth Hospital , Birmingham
• Wythenshawe Hospital , Manchester

A small number of children's lung transplants are carried out at Great Ormond Street Hospital and Freeman Hospital.

Transplant assessment

You'll need to stay in hospital forup to threedays for a lung transplant assessment.

Tests will be carried out to make sure your other major organs, such as your heart, kidneys and liver, will function properly after the transplant. These may include Blood tests and any of the following investigations:

• a chest X-ray
• an echocardiogram to check how well your heart is pumping
• an electrocardiogram (ECG) whichrecords your heart's electrical activity
• an angiogram a type of X-ray that can be used to check the blood flow in the blood vessels of your lungs

During the assessment, you'll be able to meet members of the transplant team and ask questions.Your transplant team will include:

• surgeons
• anaesthetists
• intensive care specialists
• lung specialists
• specialists in infection
• a transplant nurse
• physiotherapists
• psychologists
• social workers
• a transplant co-ordinator

The transplant co-ordinator will be your main point of contact. They'll talk to you and your family about what happens during a lung transplant and the risks involved.

After the assessment is complete, a decision will be made as to whether a lung transplant is suitable for you and whether it'sthe best option.

It may be decided that:

• you should go on the active waiting list which means you could be called for a transplant at any time
• atransplant is suitable for you, but your condition isn't severe enough you'll be reviewed regularly and if your condition worsens, you'll be put on the active waiting list
• you need more investigations or treatment before a decision can be made
• atransplant isn't suitable for you the assessment team will explain why and offer alternatives, such as medication or other surgery
• you need a second opinion from a different transplant centre

Why a lung transplant might be unsuitable

The supply of donor lungs is limited, which means there are more people who would benefit from a lung transplant than there are donor lungs.

Therefore, people who are unlikely to have a successful transplant aren't usually considered suitable for transplant.

You may also be considered unsuitable if:

• you haven't complied with previous advice or been reliable for example, if you haven't given up smoking, you have a poor history of taking prescribed medication or you've missed hospital appointments
• your other organs, such as your liver, heart or kidneys, don't function well and, therefore, may fail after the stresses of the transplant operation
• your lung disease istoo advanced, so it's thought you would betoo weak to survive surgery
• you have a recent history of cancer there's a chance that the cancer could spread into the donated lungs; exceptions can be made for some types of skin cancer as these are unlikely to spread
• you have an infection that would make the transplant too dangerous
• you have psychological and social problems that may affect whether you take post-transplant treatments; such as being addicted to drugs or having a serious mental health condition
• you're significantly underweight with a body mass index (BMI) of less than 16, or very overweight ( obese ) with a BMI of 30 or above

Age also plays a part, because of the effect it has on likely survival rates. There are no set rules and exceptions can always be made, but as a general rule:

• people over 50 years of age wouldn't be considered suitable for a heart-lung transplant
• people over 65 years of age wouldn't be considered suitable for a single or double lung transplant(although those over 65 and otherwise healthy may be considered for a single lung transplant)

The waiting list

Once you're on the active waiting list, the transplant centre may give you a pager so you can be contacted at short notice.

The length of time you'll have to wait will depend on your blood group , donor availability and how many other people are on the list (and how urgent their cases are).

While you wait, you'll be cared for by the doctor who referred you to the transplant centre. They'll keep the transplant team updated with changes to your condition. Another assessment issometimes necessary to make sure you're still suitable for a transplant.

Your transplant team will often be given short notice of donor organs, so will have to move swiftly. When a suitable donor is found, you'll usually need to be in hospital ready for your transplant within six to eight hours. If you live a long way from a transplant centre, you'll be flown to the centre or taken by ambulance.

Getting the call

When a suitable donor lung is found, the transplant centre will contact you and ask you to go to the centre.

When you hear from the transplant centre:

• don't eat or drink anything
• take all current medicines with you
• take a bag of clothes and essentials for your stay in hospital

At the transplant centre, you'll bequickly reassessed to make sure no new medical conditions have developed. At the same time, a second medical team will examine the donor lungs.

The lung transplant must be carried out as quickly as possible to ensure it has the best possible chance of being successful.