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Lung Transplant

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.

Who needs a lung transplant?

Patients with end-stage lung disease are likely candidates for lung transplants. Common causes of end-stage lung disease which require lung transplantation include:

  • Chronic Obstructive Pulmonary Disease (COPD)
  • Idiopathic Pulmonary Fibrosis (IPF)
  • Bronchiectasis
  • Pulmonary Hypertension (Primary and Secondary)

How is a lung transplant done?

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.

How is the patient evaluated for lung 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:

  • Transplant Pulmonologist: The physician who specialises in lung diseases and lung transplantation.
  • Transplant Surgeon: The surgeon who performs the operation and manages the post-operative care together with the Transplant Pulmonologist.
  • Transplant Clinical Coordinator: The main contact person from the transplant team.
  • Medical Social Worker: The person who assists in determining the patient’s financial and social ability to cope with a transplant.
  • Psychiatrist: The physician who helps to determine the patient’s ability to cope with the stress and anxiety of undergoing the transplant.
  • ID Physician: The physician who specialises in infectious diseases.
  • Dietitian: The healthcare professional who assesses the patient’s nutritional needs before the transplant operation.
  • Physiotherapist: The healthcare professional who evaluates the patient’s exercise capacity and musculoskeletal system and recommends exercise programmes for the patient to increase body strength and endurance before and after the transplant.

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.

What are the criteria for lung transplant?

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:

  • Size (height and weight)
  • Chest measurements (chest circumference and chest x-ray measurements)
  • Blood type (O, A, B or AB)

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).

How are the donors found?

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.

Can a person lead a normal life after lung transplantation?

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.

Important things to know about organ/tissue donation

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.

For more information about this programme, please contact:

Clinical Coordinator
Mechanical Circulatory Support, Heart and Lung Transplant
National Heart Centre Singapore
5 Hospital Drive
Singapore 169609
TeI: 6704 8130
Email: transplant.office@nhcs.com.sg

For more information about Transplant services, please contact:

SingHealth Transplant
Tel: +65 6326 5195
Fax: +65 6220 0730
Email: singhealth.transplant@singhealth.com.sg
Website: www.sgh.com.sg/transplant


 Information correct as of August 2014.