Initial assessment
If a heart-lung transplant is thought to be an appropriate treatment for you, it is likely that you will be invited to your local hospital for an initial assessment.
The purpose of the assessment is to check that you do not have any of the contraindications that are outlined in the page about who can receive a heart-lung transplant.
Further assessment
If no obvious contraindication can be found, it is likely that you will be invited to your nearest transplant centre to have a more in-depth assessment.
Specialist transplant centres in England that carry out heart-lung transplants are:
- London, which has two transplant centres at the Great Ormond Street Hospital for Children and the Royal Brompton and Harefield Hospital
- University Hospitals Birmingham NHS Foundation Trust
- the Freeman Hospital in Newcastle
- the Northern General Hospital in Sheffield
- the Papworth Hospital in Cambridge
- the Wythenshawe Hospital in Manchester
The purpose of having a more in-depth assessment is to build up a more detailed picture of your current state of health, and to check whether there are any underlying problems that could affect your suitability for having a transplant.
You will also be given the opportunity to meet the transplant team and to find out more about the procedure. Before visiting the transplant centre, you may find it useful to write a list of questions that you would like to ask the transplant team.
As part of your assessment, you may have some of the tests described below.
- blood and urine tests to check for viral or bacterial infections, as well as to assess the state of organs, such as your liver
- chest X-rays
- blood pressure tests
- a lung function test, which uses a machine called a pulse oximeter to measure the amount of oxygen in your blood
- computed tomography (CT) and magnetic resonance imaging (MRI) scans, which can be used to check the state of certain organs, such as your lungs
- coronary angiography, which is a special type of X-ray that can be used to study the inside of your heart
- an electrocardiogram (ECG), which is a test that can measure the electrical activity of your heart
The whole assessment process usually takes between two and four days. If your child is being assessed, the transplant centre will be able to arrange accommodation for you if you require it.
The final decision about whether you, or your child, is suitable for a heart-lung transplant is not made by one individual, it is a joint decision that is made by the transplant team as a whole.
If the decision is straightforward, you may be informed about it before leaving the transplant centre. However, if the decision is more complex, the transplant team will want to discuss all of the issues carefully. Therefore, it may be several weeks before you are informed about the decision.
Once the decision has been made, you will have the opportunity to speak in person with a member of the transplant team. If it is decided that you, or your child, are not suitable for a heart-lung transplant, you will also be given the opportunity to discuss the treatment options that are suitable for you.
The waiting list
If it is decided that you are suitable for a heart-lung transplant, your details will be added to the NHS Organ Donor Register, and you will be added to the waiting list.
You will be given a pager so that staff at the transplant centre can contact you at any time during the night or day if a donated organ becomes available. You should also keep a suitcase packed with clothes and other suitable items, so that you are ready to leave for the transplant centre as soon as you are notified.
It is your responsibility to inform the transplant centre if:
- there are any changes to your personal details, for example, if you have changed address or if you are going on holiday
- you become unwell
- you are admitted to hospital
- there are any changes to your medication
It is impossible to say how long it will take for a suitable donor to be found. It may be several months, or even years, before a donated heart and lungs of the right size and blood group become available.
Your transplant centre will be able to offer any support, guidance and information that you may need while you are waiting for a suitable donor to be found, and they will be fully aware that for many this can be both a frustrating and frightening experience.
The transplant process
Once a donated set of heart and lungs becomes available, your transplant team will contact you and arrange for transport to take you to the transplant centre as quickly as possible.
You will be taken to the operating theatre and given a general anaesthetic. A machine that is known as a heart-lung machine will be attached to your body using tubes that are inserted into your blood vessels. The machine will pump oxygen-rich blood around your body until the operation is complete.
An incision (cut) will be made in your chest, and your heart and lungs will be removed. The donated set of heart and lungs will then be put in place and reconnected to the surrounding blood vessels. The incision in your chest will be stitched up, and you will be transferred to an intensive care unit (ICU) where your recovery will be closely monitored.
A heart-lung operation usually takes several hours to complete.
