Transplant Services

A lung transplant is a type of surgery that replaces one or both of your damaged or diseased lungs with a donor’s healthy lungs. It’s a necessary procedure if you have a lung condition or injury that doesn’t respond to other treatments.

Patients who are considering lung transplant as a treatment option require a full evaluation of not just their disease but its impact on their bodies and other organ systems as well. That evaluation includes myriad medical tests and an assessment of their social, lifestyle, psychological states, family support, and other medical comorbidities. Once we determine that none of those factors would be inhibitive to having a good outcome or predictive of not having a bad outcome after their lung transplant, would we would consider their candidacy for this life-altering treatment.

Our lung transplant program wait times are something that we're quite proud of. The majority of people receive a transplant within two months of being listed for their transplant. This happens as the team is focused and rallies around every patient and caregiver, to bring them up to speed with lifestyle changes, education, physical rehabilitation, nutritional supplementation & psychological support that would be needed to get them, in the best shape before they are transplanted. This is the only transplant service nationally that utilizes all these resources consistently and effectively, to deliver expected positive outcomes, closely monitored long term care, and great survival. I like to think of transplantation as personalized medicine, where the patient is at the center of a team of a highly experienced, motivated, committed, and compassionate set of medical professionals.

Your lung transplant journey starts with a referral from your primary physician or referring pulmonologist. Our administrative team will connect you with our lung transplant pulmonologist. During this appointment, you will learn about your current health status and outlook in much greater and elaborate detail. After this appointment and your consent, the lung transplant pulmonologist will ask the transplant evaluation team to plan a transplant assessment.

Having a lung transplant is a big decision. You need to understand the benefits, risks, and program requirements. The evaluation helps to determine if transplantation is the right treatment for you and ensures that it is as safe as possible for you to have a transplant. The assessment process will involve coming to the hospital to have a number of tests, and meeting with key members of your team. The assessment process will give you, your family, and our team the information to make an informed decision about having a lung transplant. Once your assessment is complete, the transplant team will meet to review your results. This assessment process can take up to one week (seven days). Your transplant coordinator will call you to meet our specialists that include pulmonologists, surgeons, intensivists, nutritionists, psychologists, infectious disease specialists, transplant coordinators, physiotherapists, and financial counselors to discuss the results of your assessment after the pre-transplant selection meeting.

Evaluation and selection of patients for transplantation is the result of a coordinated process, which looks at the whole patient. While you can be screened for basic eligibility outside the centre, a comprehensive evaluation will require a visit to the Heart and Lung Transplant Institute. Patients with end-stage lung disease requiring life support may be considered for inpatient transfer for urgent evaluation and listing, however, this is an exceptional circumstance and is guided and monitored by the organ allocation policy of, the regional organ allocation body that is governed and monitored by the Department of Health.

Evaluation is conducted in stages and is customized to efficiently address key issues that might prohibit transplantation in a particular patient. After the evaluation is completed, the patient’s case is discussed in the multidisciplinary transplantation-evaluation conference. A complete presentation is made, and opinions welcomed from all participants in the program. The decision about eligibility for transplantation is made with everyone’s consensus.

The patient has a progressive, potentially fatal lung disease that substantially impairs the quality of life and daily function, and for which all alternative medical and surgical treatments short of lung transplantation have been exhausted.

The patient’s lung disease is not expected to recur and cause disability within five years.

The patient is not moribund, and the lung transplant is likely to prolong life for at least five years (with a five-year survival rate of over 50%) and the lung transplant will restore the patient to a range of physical and social function suitable for the activities of daily living.

The patient does not any conditions or diseases of a major system (e.g., cardiovascular or that would preclude surgery or indicate a poor potential for rehabilitation.

The patient’s psychological assessment, social arrangement, and family support indicate a reasonable expectation that the patient will adhere to the strict long-term medical regimen that will be required post-transplant.

The patient has no active substance abuse.

The patient has completed at least six months of documented rehabilitation and sobriety and has psychological clearance.

The patient has demonstrated the severity of illness that merits a transplant and has no absolute contraindication to the procedure.

The patient undergoes a comprehensive assessment, which is reviewed by the multidisciplinary transplantation committee.

Usually, we consider lung transplantation in persons with end-stage lung disease who are less than 65 years of age for a double lung or heart-lung transplant, and less than 70 for a single lung transplant. However, there is no absolute age contraindication and we consider patients based on their physiological age rather than the chronological age. However, long-term survival does favor younger patients as co-morbid illnesses increase with the aging process.

Immediately before transplant, we will do a few tests and you will receive anti-rejection medications and antibiotics. There is a chance that the surgery will be canceled at the last moment as the team is assessing the donor lungs right up to the moments before the surgery. If the organ is found to be sub-optimal the call will be terminated, and you will be discharged home. It is not unusual for this to happen a couple of times. In the operating room, you will be given medication to keep you unconscious.

Several tubes are inserted into your body, including an endotracheal tube, which is a breathing tube that extends from your mouth into the lungs, an intravenous line in your neck, a nasogastric or “NG” tube that goes into your stomach through your nose, and a urinary catheter that drains urine freely into a bag. The surgery itself can take 8 or more hours depending on your condition and whether you have a double or a single lung transplant.

Some people need to have their lung or heart function supported by machines before, during, or after the surgery. Your chest will be opened between the ribs in the front across the breast bone or at the side. The diseased lungs will be removed and replaced with the donor lungs, one at a time. The new lung will be connected to the main bronchus, the pulmonary artery, and the pulmonary vein. After the lung is connected, the surgeons will leave drainage tubes around the lungs and heart and carefully close the layers of bone, muscle, and skin. After the surgery, you will be taken to the intensive care unit or ICU. You will remain there until you can breathe without the help of the ventilator, or breathing machine, and until your condition is stable.

Right before transplant, we will do a few last-minute tests and you will receive anti-rejection medications and antibiotics. There is a chance that the surgery will be canceled at the last moment as the team assesses the donor lungs right up to the moments before the surgery. If the organ is found to be sub-optimal the call will be terminated, and you will be discharged home. It is not unusual for this to happen more than once.

In the operating room, you will be under general anaesthesia, and your bodily functions will be supported by external tubes. There will be an endotracheal tube, which is a breathing tube that extends from your mouth into the lungs, an intravenous line in your neck, a nasogastric or “NG” tube that goes into your stomach through your nose, and a urinary catheter that drains urine freely into a bag.

The surgery itself can take 8 or more hours depending on your condition and whether you have a double or a single lung transplant. Some people need to have their lung or heart function supported by machines before, during, or after the surgery. Your chest will be opened between the ribs in the front across the breast bone or at the side. The diseased lungs will be removed and replaced with the donor lungs, one at a time. The new lung will be connected to the main bronchus, the pulmonary artery, and the pulmonary vein. After the lung is connected, the surgeons will leave drainage tubes around the lungs and heart and carefully close the layers of bone, muscle, and skin.