A lung transplant is a surgical procedure to replace a diseased or failing lung with a healthy lung, usually from a deceased donor. A lung transplant is reserved for people who have tried medications or other treatments, but their conditions haven't sufficiently improved.

Depending on your medical condition, a lung transplant may involve replacing one of your lungs or both of them. In some situations, the lungs may be transplanted along with a donor heart.

While a lung transplant is a major operation that can involve many complications, it can greatly improve your health and quality of life.

When faced with a decision about having a lung transplant, know what to expect of the lung transplant process, the surgery itself, potential risks and follow-up care.

Unhealthy or damaged lungs can make it difficult for your body to get the oxygen it needs to survive. A variety of diseases and conditions can damage your lungs and keep them from functioning effectively. Some of the more common causes include:

• Chronic obstructive pulmonary disease (COPD), including emphysema
• Scarring of the lungs (pulmonary fibrosis)
• Cystic fibrosis
• High blood pressure in the lungs (pulmonary hypertension)

Lung damage can often be treated with medication or with special breathing devices. But when these measures no longer help or your lung function becomes life-threatening, your health care provider might suggest a single-lung transplant or a double-lung transplant.

Some people with coronary artery disease may need a procedure to restore blood flow to a blocked or narrowed artery in the heart, in addition to a lung transplant. In some cases, people with serious heart and lung conditions may need a combined heart-lung transplant.

Factors that may affect your eligibility for a lung transplant

A lung transplant isn't the right treatment for everyone. Certain factors may mean you're not a good candidate for a lung transplant. While each case is considered individually by a transplant center, a lung transplant may not be appropriate if you:

• Have an active infection
• Have a recent personal medical history of cancer
• Have serious diseases such as kidney, liver or heart diseases
• Are unwilling or unable to make lifestyle changes necessary to keep your donor lung healthy, such as not drinking alcohol or not smoking
• Do not have a supportive network of family and friends

Complications associated with a lung transplant can be serious and sometimes fatal. Major risks include rejection and infection.

Risk of rejection

Your immune system defends your body against foreign substances. Even with the best possible match between you and the donor, your immune system will try to attack and reject your new lung or lungs. The risk of rejection is highest soon after the lung transplant and is reduced over time.

Your drug regimen after transplant includes medications to suppress your immune system (immunosuppressant medications) in an effort to prevent organ rejection. You take these anti-rejection drugs for the rest of your life.

Side effects of anti-rejection drugs

Anti-rejection drugs may cause noticeable side effects, including:

• Weight gain
• Unwanted hair growth or hair loss
• High cholesterol
• Stomach problems

Some anti-rejection medications can also increase your risk of developing new conditions or aggravating existing conditions, such as:

• Diabetes
• Kidney damage
• Osteoporosis
• Cancer
• High blood pressure (hypertension)

Risk of infection

Anti-rejection drugs suppress your immune system, making your body more susceptible to infections, particularly in your lungs.

To help prevent infections, your doctor may recommend that you:

• Wash your hands regularly
• Brush your teeth and gums regularly
• Avoid contact with pets and avoid cleaning pet areas
• Protect your skin from scratches and sores, such as from razors or nail files
• Avoid sharing utensils
• Avoid crowds and people who are ill
• Receive appropriate vaccinations

Preparations for a lung transplant often begin long before the surgery to place a transplanted lung. You may begin preparing for a lung transplant weeks, months or years before you receive a donor lung, depending on the waiting time for a transplant.

Taking the first steps

If your health care provider recommends that you consider a lung transplant, you'll likely be referred to a transplant center for evaluation. You're also free to choose a transplant center on your own. When evaluating a lung transplant center:

• Check with your health insurance provider to see which transplant centers are covered under your insurance plan.
• Consider the number of lung transplants a center performs each year and transplant recipient survival rates. You can review this information in a database on the web maintained by the Scientific Registry of Transplant Recipients.
• Consider additional services that may be provided by a transplant center. These can include support groups, assistance with travel arrangements and help finding local housing for your recovery period. The transplant center may also provide information about organizations that can help with these concerns.

Once you decide where you would like to have your lung transplant, you'll need to have an evaluation to see if you're eligible for a lung transplant. During an evaluation, your health care providers and transplant team review your medical history, conduct a physical examination, order many tests, and evaluate your mental and emotional health.

Your transplant team also discusses with you the benefits and risks of a transplant and what to expect before, during and after a transplant.

Waiting for a donor organ

If the transplant team determines that you're a candidate for a lung transplant, the transplant center will register you and place your name on a waiting list. The number of people needing lung transplants far exceeds the number of donated lungs available. Unfortunately, some people die while waiting for a transplant.

While you're on the waiting list, your health care team will closely monitor your condition and make changes to your treatment as needed. Your health care provider may recommend healthy lifestyle changes, such as eating a healthy diet, getting regular exercise and avoiding tobacco.

Your health care providers may recommend that you participate in a pulmonary rehabilitation program while you wait for a donor lung. Pulmonary rehabilitation can help you improve your health and ability to function in daily life before and after your transplant.

When a donor organ becomes available, the donor-recipient matching system administered by the United Network for Organ Sharing (UNOS) finds an appropriate match based on specific criteria, including:

• Blood type
• Size of organ compared with chest cavity
• Geographic distance between donor organ and transplant recipient
• Severity of the recipient's lung disease
• Recipient's overall health
• Likelihood that the transplant will be successful

Immediately before your transplant surgery

It may take months or even years before a suitable donor becomes available, but you must be prepared to act quickly when one does. Make sure the transplant team knows how to reach you at all times.

Keep your packed hospital bag handy — including an extra 24-hour supply of your medications — and arrange transportation to the transplant center in advance. You may be expected to arrive at the hospital within just a few hours.

Once you arrive at the hospital, you will undergo tests to make sure the lung is a good match and that you are healthy enough to have the surgery. The donor lung also must be healthy, or it will be declined by the transplant team. The transplant will be canceled if it doesn't appear that the surgery will be a success.

A lung transplant can substantially improve your quality of life. The first year after the transplant — when surgical complications, rejection and infection pose the greatest threats — is the most critical period.

Although some people have lived 10 years or more after a lung transplant, only about half the people who undergo the procedure are still alive after five years.