I'm John Dark. I'm a consultant surgeon

and head of the heart and lung transplant programme

at the Freeman Hospital in Newcastle upon Tyne.

Several categories of patients need lung transplants.

The largest are those with cystic fibrosis,

and they comprise about a third of all our patients.

We do lung transplants for patients with emphysema

when that disease is very severe and at the end stage.

There are some older patients with lung fibrosis

and some patients with disease of the blood vessels running into the lung,

who have very high pressure in those lungs, called pulmonary hypertension.

They need lung transplants or sometimes combined heart and lung transplants.

Most patients will have had their disease for many years.

The cystic fibrosis patients, for instance, are born with the disease.

They used to die in their teens but care is now very good

and they come to us in their 30s and even 40s needing a transplant.

Patients are referred to us when they're near the end stages of their disease,

when their local physicians

think they are at risk of dying of failure of the lungs.

We then see them for an assessment

and work out if they are bad enough for a transplant.

There's a limited number we can do every year.

We make sure we've explored all the other options for treatment

and we make sure the rest of the body is fit enough for a transplant.

If we think you need a transplant and you're bad enough for a transplant,

and if we think that you will survive a transplant,

then we would put you on our waiting list.

The average wait is often a year and can be even two years,

waiting for a suitable organ to come along.

You may receive a pair of lungs, what we call a bilateral lung transplant,

and we have to do that if you've got an infective condition like cystic fibrosis

because we have to remove all the infected material.

Some patients can just have a single lung

and we can do that on either the left or the right side.

That's a simpler, more straightforward, operation.

Whichever operation you need, we bring you in when a donor organ

of the right size and right blood group comes available.

Single-lung transplants are done through an incision

through the side of the chest, round the side, underneath the armpit.

If you need a pair of lung transplants,

we'd probably do an incision that runs right across the middle of the chest.

In ladies it comes underneath the breasts.

This is major chest surgery and recovery often takes quite a long time,

particularly for patients who've been very sick beforehand.

But we would anticipate getting back to a completely normal level of function.

I've had patients who have climbed mountains, gone back to work,

had families after lung transplantation.

There's no limit to what you can do.

After the transplant you need to be on quite complicated medication,

three or four tablets several times a day for the rest of your life.

You also need medication to stop you getting infections

because one of the side effects of the immunosuppression

is that you're more open to infections and more open to some forms of cancer.

Having a lung transplant is complicated.

There are lots of rules to follow and the follow-up is very detailed.

You'll be seen regularly in our outpatient clinic.

Even ten years after a transplant,

you'd need a blood specimen every six weeks.

We're only doing about 150 lung transplants a year

in the United Kingdom,

and up to 30 per cent of the patients on our waiting list

will die before receiving a new organ.

One of the big limitations is the availability of donor organs,

and we do want people to remember

that donating organs of a loved one who's died of a catastrophe to the brain

can help one or two people with lung disease,

as well as other people with heart, kidney and liver disease,

to live for many years afterwards.