The candidate for a lung transplant is almost always a patient with a terminal lung disease, whose life expectancy does not exceed 12-18 months, according to the attending physician. And even a walk of about a hundred meters in the plain is a supreme effort for them. However, not everyone who meets this description is accepted for a transplant. The candidate’s personality is crucial; he must have a mature and mature character. And commit to the care and follow-up that follows.
Towards the time of transplantation, the patient should be rewarded, if possible, with the use of cortisone. Before transplantation, several tests must be performed – an echocardiogram, a cardiac mapping to rule out the possibility of heart dysfunction. In patients over 45, coronary artery bypass grafting should be performed to rule out coronary artery disease. The patient’s age does not constitute an absolute contraindication. Still, it is now customary not to transplant patients over 65 years of age, as the results observed to date in this age group are not as good as those observed among younger transplant recipients.
Single or double lung transplant instructions
To make the most of the donated organs, it is better to take two individual lungs and a heart from one donor, thus giving three patients the vital organ for the rest of their lives. Therefore, professionals worldwide tend to transplant a single lung, except in situations where both of the patient’s lungs are infected.
In general, lung diseases are divided into “dry” diseases, i.e., diseases in which healthy scars form that take the place of the bubbles and thus impair blood oxidation, and “wet” conditions, in which most of the damage occurs due to purulent infections of the airways. Only one lung transplant can be sufficient in patients with “dry” lung diseases, without functional disorders such as emphysema and fibrosis, and in patients with pulmonary hypertension. In contrast, in patients suffering from “wet” lung diseases (originating from infection) such as cystic fibrosis, it is necessary to “replace” both lungs due to the fear of infection of the implant by the remaining infected lung.
The accepted professional opinion is that there are no transplant patients who suffer from systemic diseases, such as autoimmune disease and unbalanced diabetes, or patients who suffer from failure of other systems (kidney, liver, or heart). Also, there are no sick transplanters whose nutritional or mental condition is poor. Today, with the accumulation of clinical experience in lung transplants, many counter-parents, previously considered absolute, have become relative parents only. All, for example, have previously avoided transplantation of patients treated with cortisone preparations. Still, today several centers successfully transplant patients treated with steroids in reasonable doses (5-15 mg per day). However, it is recommended to avoid transplantation in patients treated with high doses. Patients who underwent thoracic surgery, as these patients tended to bleed as a result of separating the adhesions of old surgical scars during the operation. Still, transplants are also successfully performed on patients who have undergone limited surgery to open the thorax.
In addition, in the past, it was not customary to transplant patients suffering from cystic fibrosis and diabetes; however, today, many centers in the world perform transplants among these patients and with great success.
Donor selection and matching between donor and recipient
Organ donation is always welcome, however not every lung from a donor is suitable for transplant. Lung should be avoided from patients who have undergone trauma or trauma to the chest, or from a donor suffering from an active lung infection, or one who has had a prolonged artificial respiration (over 5 days). Once the lung has been found suitable for transplantation it should be checked whether it is suitable for the patient applying for the transplant. The match is determined according to only two indicators: 1. Lung size. 2. Blood type (ABO)
The course of surgery and subsequent treatment
The course of surgery of a single lung transplant
At the beginning of the operation, the patient is laid on his side, and an incision is made in the chest. The diseased lung is removed, usually without the need to connect to a heart-lung machine, except in situations where there is particularly increased pulmonary pressure. The donor’s left atrial sleeve containing the pulmonary veins, from that lung to the main artery, is then connected to the donor’s bronchus. In most cases, the patient is under anesthesia with one lung at the time of removal of the other lung.
The course of surgery for a double lung transplant
Today, it is common to transplant one lung immediately after the other lung in the same way. First, the diseased lung is removed, usually without connection to a heart-lung machine, but the second lung is resuscitated. And then move on to the double lung transplant when inhaling the transplanted lung.
In such a transplant, a transverse section is used using the pearl shell method (which opens upwards).
Routine postoperative drug therapy is based on triple therapy with cyclosporine, tacrolimus, more, and cortisone. The usual initial treatment is high-dose cortisone preparations for three days in rejection events. In case of prolonged delay, the treatment can be repeated 2-3 times.
Immediately after transplantation, the patient should be quickly weaned from the ventilator (usually within 24 hours). Prolonged use of invasive aids, such as arterial centering, should be avoided to prevent infections during this period characterized by poor immune systems.
Post-transplant treatment includes closely monitoring lung function and performing bronchoscopies and lung biopsies. In the first month after the transplant, the lung function test is conducted twice a week, then the test is performed once a week, and later, the frequency of the tests decreases. The bronchoscopy is routinely performed once a week in the first month of the transplant, and the frequency of tests decreases during the first three months of the transplant. The bronchoscopy makes it possible to see the launching area of the bronchus and detect by biopsies and flushing of bacteria, viruses, and healthy fungi signs of infection or rejection.
The story of Rotem Shai
My name is Rotem Shai (formerly Sharabi), and I am now 30 years old and live in Kiryat Arba; I have been involved in music and playing the guitar since the age of 14, and have been performing on stages around the country for 12 years.
Unlike many others, cf disease met me at a late age and I did not grow up like an average cf child. In twelfth grade, I started having breathing problems when I practiced insane poisoning every day with friends in a boarding school for the military. Since then, it only got worse until, at age 20, I found myself in intensive care (according to doctors) after a severe pneumonia that struck me.
At this point, when I arrived at Shaare Zedek Hospital and was put to sleep for about a month, I was diagnosed with CF and as a transplant candidate. When I recovered in Gaza and the fantastic doctors, I first met with the daily routine of the cf patients and lived with it for about seven months until the transplant. During this time, I was treated by Prof. Eitan Kerem and his fantastic staff, who gave me a feeling of family and confidence that I was in the best place to relax, and it was… It sounds like everything fell on me in a boom, but now, for some reason, I took it easy, And I came to terms with the situation relatively quickly. The truth is that it was not supposed to be like this, because in my life I was not in the hospital until that moment at the age of 20 (since of course I am in a Catholic wedding with a hospital) only I was lucky and did not get depressed or anything. Everything came to me quickly and I even developed a sense of humor about the situation…
I went through the transplant through a lot of hardships, and it took me a month to get out of the intensive care unit and also there, I was defined in a challenging situation. When I left, I was finally taken to rehabilitation at Tel Hashomer, which lasted about a month. Today, I am 9 and a half years after the transplant, and BH feels excellent. Six and a half years ago I met an extraordinary girl who wanted to study guitar with me (there was no lesson at the end) 😉 and today, she is my amazing wife, we got married four and a half years ago, and we at BH live in happiness and health.
Organ transplantation is a modern medical technology that has developed in recent years, intending to replace organs that have reached insufficiency with normal organs. As transplants’ ability became more sophisticated, the demand for organs increased, and there was a growing shortage of organs for transplantation.
In recent years, the proportion of transplant recipients out of all those who need a transplant is still low due to a lack of organ donation for the transplant. One can learn about the shortage of organ transplants in Israel from the difference between the number of those waiting for a transplant and the number of actual transplants each year. Thus, in 2004 747 people waited for a transplant in Israel, and in practice, there were only 244 transplants this year.
National Transplant Center and Eddie
The National Transplant Center was established in 1993 as a unit in the Ministry of Health and is the exclusive state body that coordinates organ donation and organ transplantation in Israel. Its main objectives:
Increasing organ donation in Israel.
· Optimal utilization of the organs to be transplanted.
· Activation of an equal and transparent policy in the allocation of organs.
· Management of a quality assurance system in donations and transplants.
The National Transplant Center operates the “Eddie” organization, which maintains a computerized database of Israeli residents who have stated that they are willing to donate organs after their death.
Only 4% of the population in Israel, which is about 250,000 citizens, carry an organ donation card – “Eddie card,” which informs about a person’s willingness to donate organs for transplantation after death – compared to 15-35 percent of the public in other Western countries.
In Israel, there is even a practice according to which the consent of the cardholder’s family to the willingness to donate organs must also be obtained, and the permission of the donor is not satisfied, which is expressed in the actual possession of the card.
Any Israeli resident over 18 can join Eddie by signing a donor notice.
To sign an Eddie card, click here.