Q. How do you get on the list to receive a lung transplant?
A. Following initial testing, Ohio State’s transplant team evaluates the information gathered and determines whether transplantation is a safe and appropriate option. We will also determine what additional information is needed prior to placing you on the transplant list.
If approved for transplant listing, the final step involves approval by the Ohio Solid Organ Transplantation Consortium (OSOTC). The OSOTC has a committee comprised of representatives from other transplant programs in Ohio and other members who approve all patients for lung transplant listing in the state of Ohio. When approved by the OSOTC, you are then listed for lung transplantation on the United Network for Organ Sharing (UNOS) national waiting list. A letter is sent to your insurance company providing recommendations for transplantation and requesting approval.
Q. What affects the wait time prior to the transplant?
A. Your wait time can depend on multiple factors such as your blood type, body size and the severity of your illness. The wait time could be from days to years.
During the waiting period, you will continue to follow up with Ohio State's transplant physicians so we may update your Lung Allocation Score (LAS) every two-three months. You must submit to random drug, nicotine, alcohol screening. You must be reachable at all times, usually with a cell phone.
Also after listing, you will meet with our social worker and transplant coordinator, as will your family and any support persons identified for an orientation. You will sign a contract which details patient expectations and outlines expectations patients can have of Ohio State’s lung transplant team.
Q. What is involved in evaluation testing prior to the transplant?
A. You will be scheduled for a full outpatient clinic evaluation to determine whether you are a transplant candidate.
Testing includes lung tests, several types of imaging of the lungs, evaluation of your heart, test of your physical stamina, dental appointments, colonoscopy and, for females, Pap smears and mammograms. Should you already have any of these done, please bring those reports with you to your appointment.
During your outpatient clinic evaluation visit, our goal is to have all the pre-transplant initial testing, lab work (including tissue typing) and an array of clinical testing, education, surgeon interview and social work consultation completed as quickly as possible.
Every patient being evaluated for a lung transplant will have a psychosocial assessment with multiple choice questions and a meeting with a transplant social worker. The purpose of this evaluation is to help determine if you have the psychological stability, motivation and personal support to meet the challenges of transplantation.
Following initial testing, the transplant team evaluates the information gathered and determines whether transplantation is safe and appropriate. We will also determine what additional information is needed prior to placing you on the transplant list. These tests are customized based on your history and conditions, thus avoiding unnecessary testing and costs. It is preferred that these tests be completed at Ohio State’s Wexner Medical Center, but depending on your geographic location or payer preference, they may be completed closer to your home.
During the pre-transplant clinic visit, you will take part in a comprehensive education program that details the surgical procedure, medications, recovery and rehabilitation associated with the transplant process.
Q. What is tissue typing?
A. The Tissue Typing Laboratory assures that a graft is compatible with its recipient. The process involves matching a person's unique configuration of six human leukocyte antigen (HLA) molecules with a potential pool of approximately 100 different varieties.
Cross-match testing helps prevent some types of rejection. The testing involves mixing cells from the donor's and recipient's serum to determine whether rejection promoting antibodies will occur. This information helps your physicians plan for the right medication strategy to best control rejection.
Transplant support testing includes monitoring new drugs that patients use, testing to determine a patient's overall ability to maintain a graft, and developing new tests to support many of the clinical aspects of transplantation.
Q. What are the contracts and agreements for receiving a lung transplant?
A. Taking care of your new lungs can determine your success after transplant. We expect our patients to participate in pulmonary rehabilitation. Changing harmful habits should be a priority, as our program does not consider patients who are current smokers or alcohol or drug dependent. Potential recipients must be substance-free for at least six months before being listed for transplant. We will perform random testing. A positive test result could result in your removal from our list. Our program has no tolerance for tobacco use nor alcohol or drug abuse. Lung transplant recipients who return to smoking will not be considered for re-transplant.
If you are deemed a candidate for lung transplant, you will be asked to sign a written contract that states you understand and agree to commit to the process. If you have a tobacco, alcohol or drug history, you will be asked to sign an abstinence agreement as well. Sample contracts are available from your lung transplant coordinator. Please talk with your coordinator should you have any questions regarding these contracts and agreements.
Q. How long is the lung transplant hospital stay?
A. Upon completion of the surgery, you will be closely monitored in an ICU setting for complications.
You will be on a ventilator with multiple intravenous access devices and monitoring devices along with medications to support the lungs. Usually, you will be weaned from the ventilator and out of bed within a day or two after your operation.
Transplant education is started within a few days of the surgery. The emphasis is placed on self-administration of the many medications as well as post-operative restrictions.
The average length of stay for a lung transplant patient is seven to 14 days.
Q. How will I adjust to the lifestyle and nutritional changes I’ll need to make after surgery?
A. Licensed Independent Social Workers (LISW) specially trained in transplant assist you in adjusting to lifestyle changes brought on by your disease and its treatment. A registered dietitian specializing in the care of transplant patients will assist you by individualizing your nutritional care and educating you about your dietary needs.