The surgeon first inspects the donor’s lungs for any symptoms of disease or damage. If lung(s) are approved, recipient is connected to IV line and several equipments that monitor the patient. General anaesthesia is given to patient and a machine to breathe for patient.
Nearly, an hour is needed for preoperative preparation of patient. About 4 – 8 hours are required for single lung transplantation and about 6 – 12 hours for double lung transplantation.
Lobe and Single-Lung Transplantation:
Lung with worse pulmonary function is opted for replacement. Prior importance is given to replace right lung, if both the lungs function equally. This is because this prevents having maneuver near heart.
Initially, donor’s lung is inspected and later recipient’s decision is taken for transplantation. Generally, an incision is made under breastbone or under shoulder blade around chest that ends near sternum. In single lung transplant, lung collapses, blood vessels in lung are tied and at bronchial tube lung is removed. Donor’s lung is replaced , lung is inflated and blood vessels are reattached. Bronchoscopy is performed to ensure lung is satisfactory and also for clear mucus and blood in new lung. Incision in chest is closed, once the doctors are satisfied with the lung performance.
Double-Lung Transplantation:
This is also called bilateral transplant. This may be performed either en bloc, simultaneously or sequentially. Sequential is more frequent than en bloc. This is similar to 2 separate single-lung transplantation.
Donor lungs are inspected first and decision for transplantation is made. Incision is made under patient’s armpit around sternum and later towards other armpit. This incision is called clam-shell incision. In sequential procedure, lung with worse pulmonary function is collapsed, blood vessels are tied and bronchial tube is removed. New lung is replaced and blood vessels are attached. Bronchoscopy is performed to ensure the lung is satisfactory prior transplanting the other. Once the surgeons are satisfied, second lung is replaced. In 10 – 20% of bilateral transplantation, a heart-lung machine is attached for pumping blood and fresh oxygen to the body.
