Heart-lung transplantation
| Heart–lung transplant | |
|---|---|
| ICD-9-CM | 33.6 |
| MeSH | D016041 |
A heart–lung transplant is a procedure carried out to replace both heart and lungs in a single operation. Due to a shortage of suitable donors and due to the fact that both heart and lung have to be transplanted together, it is a rare procedure; only about a hundred such transplants are performed each year in the United States.
Most candidates for heart–lung transplants have life-threatening damage to both their heart and lungs. In the US, most prospective candidates have between twelve and twenty-four months to live. At any one time, there are about 250 people registered for heart–lung transplantation at the United Network for Organ Sharing (UNOS) in the USA, of which around forty will die before a suitable donor is found.
Conditions which may necessitate a heart–lung transplant include:
Candidates for a heart–lung transplant are usually required to be:
Dr. Norman Shumway laid the groundwork for heart lung transplantation with his experiments into heart transplantation at Stanford in the mid 1960s. Shumway conducted the first adult heart transplant in the US in 1968.
Building on his research at Stanford, Dr. Bruce Reitz performed the first successful heart–lung transplant on Mary Gohlke in 1981 at Stanford Hospital. The transplant team at Stanford is the longest continuously active team performing these transplants.
The patient is anesthetised. When the donor organs arrive, they are checked for fitness; if any organs show signs of damage, they are discarded and the operation cancelled. Some patients are concerned that their organs will be removed and the donor organs won't be suitable. Since this is a possibility, it is standard procedure that the patient is not operated on until the donor organs arrive and are judged suitable, despite the time delay this involves.
Once suitable donor organs are present, the surgeon makes an incision starting above and finishing below the sternum, cutting all the way to the bone. The skin edges are retracted to expose the sternum. Using a bone saw, the sternum is cut down the middle. Rib spreaders are inserted in the cut, and spread the ribs to give access to the heart and lungs of the patient.
The patient is connected to a heart–lung machine, which circulates and oxygenates blood. The surgeon removes the failing heart and lungs. Most surgeons endeavour to cut blood vessels as close as possible to the heart to leave room for trimming, especially if the donor heart is of a different size than the original organ.
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