Lung transplantation is an effective treatment for patients with end-stage lung disease — a condition where the lungs are so diseased that they can no longer perform their normal function to obtain sufficient oxygen for the body.
The National Heart Centre Singapore (NHCS) set up the lung transplant programme in 2000. To date, about 10 lung transplants have been carried out, giving recipients a new lease of life. The NHCS is the only healthcare institution in Singapore that carries out lung transplantations.
Patients with end-stage lung disease are likely candidates for lung transplants. Common causes of end-stage lung disease which require lung transplantation include:
Lung transplantation involves removing the diseased lung or lungs from the recipient and replacing either one (single lung transplant) or both (bilateral lung transplant) with healthy ones from a recently deceased donor. Lung transplantation represents the best hope for patients with end-stage lung disease as it can offer patients better quality of life after the transplant.
Evaluation of the patient’s condition is currently done in the hospital where his underlying lung condition and prospects of a successful transplant are thoroughly reviewed.
During this evaluation period, the patient will meet and speak with various members of the transplant team:
The evaluation work-up will include a series of blood tests and the condition of the heart, lung, liver and kidney systems. Potential transplant recipients are required to be substance-free at least a year before being listed for the transplant. Harmful habits such as smoking and alcohol or mind-altering drug dependency must be avoided.
When the transplant team decides that a patient is suitable for transplantation, the patient’s name will be placed on the waiting list. Donor lungs are matched with recipients according to the following criteria:
The quality of the donor lungs is of utmost priority. Donor lungs are thoroughly evaluated by the lung transplant team. The evaluation includes examination of the donor’s chest x-ray, medical history, social history (with particular emphasis on tobacco and substance abuse), amount of oxygen in the blood (arterial blood gases) and bronchoscopy (direct visualisation of the donor airway with an endoscope).
Donors are individuals who are brain-dead, meaning that the brain shows no signs of life while the person’s body is being kept alive by artificial means. Most donors are those who have died due to road accidents, strokes or severe head injuries.
Depending on the availability of a lung for transplant, patients may have to wait for months to years.
Patients will be strongly encouraged to participate in a pulmonary rehabilitation programme. The programme focuses on monitored physical exercise to help patients build their strength and endurance in preparation for the transplant and increase the chances of a successful outcome following the transplant.
The quality of life for patients improves dramatically after a lung transplant and they are able to lead more active lifestyles, which includes returning to work. Patients, however, must take several medications for life after a lung transplant. The most important drugs are those that keep the body from rejecting the transplant. A patient’s survival depends on many factors, including age, general health and response to the transplant.
The survival rate after lung transplantation worldwide is reported to be 92%, 79% and 63% for the first month, first year and third year respectively. Early mortality (<90 days) is most often due to infection and late mortality (>90 days) is most often related to rejection. Survival rates are higher for patients undergoing lung transplantation for COPD compared to those whose indications were IPF or pulmonary hypertension.
The Human Organ Transplant Act (HOTA) allows for the kidneys, liver, heart and corneas to be recovered in the event of death from any cause for the purpose of transplantation. Singapore Citizens and Permanent Residents above 21 years of age and of sound mind are included under HOTA unless they have opted out.
The Medical (Therapy, Education and Research) Act (MTERA) allows for any person above 18 years of age to pledge to donate their organs/tissues, or any body part or the whole body for the purpose of transplantation, education or research upon death. In the case where a person has not made a pledge under MTERA before passing away, the family members would be able to donate the organs and/or tissues or whole body of their loved ones under MTERA upon their death if they wish to do so. For more details on HOTA and MTERA, log on to www.liveon.sg or contact the National Organ Transplant Unit at +65 6321 4390.
Clinical Coordinator Mechanical Circulatory Support, Heart and Lung Transplant National Heart Centre Singapore 5 Hospital Drive Singapore 169609 TeI: 6704 8130 Email: firstname.lastname@example.org
For more information about Transplant services, please contact:
SingHealth Transplant Tel: +65 6326 5195 Fax: +65 6220 0730 Email: email@example.com Website: www.sgh.com.sg/transplant
Information correct as of August 2014.
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