A Heart-Lung Transplant is a major surgical procedure. It is used to treat people who have severe, or life-threatening, conditions that are affecting both their Heart and their Lungs, such as severe congenital heart disease (birth defects that affect the normal working of the heart). 

A Heart-Lung Transplant is a complex and demanding procedure that carries a high risk of complications, some of which can be fatal. Therefore, a Heart-Lung Transplant is usually only performed when all other treatment options have been exhausted, and there is compelling evidence to suggest that the benefits of the transplant outweigh any risks. 

Hearts are taken from brain-dead people. Although there is no activity in their brain, and they are legally dead, a ventilator can be used to keep their heart beating and oxygen circulating through their blood. However, the prolonged use of a ventilator can damage the lungs and make them unsuitable for transplant. 

The second problem is that lung tissue rapidly deteriorates once it has been removed from the body. Therefore, a successful donation is only usually possible if the transplant is carried out within 4-6 hours of the lungs being removed from the donor.  

The Heart and Lungs work in close partnership with each other. Healthcare professionals use the term ‘cardiothoracic’ to describe this partnership. 

The partnership of the heart and lungs means they work together in the following way: 

• the heart pumps oxygen-rich blood from the lungs to the rest of the body (the cells of the body) 
• the body’s cells use oxygen for energy 
• the oxygen-poor blood is then pumped back into the lungs 
• the lungs supply the blood with more oxygen, and 
• the process starts again 

Due to the important partnership that exists between the heart and the lungs, any underlying problems with the heart can damage the lungs and vice versa. Therefore, to effectively treat certain health conditions, it is necessary to replace both organs. 

Common Reasons for Heart-Lung Transplants 

There are several different reasons why a Heart-Lung Transplant may be required. Some of the reasons are outlined below. 

Congenital Heart Disease 

Congenital heart disease is a condition where children are born with birth defects that affect their Hearts. 

In some cases of congenital heart disease, damage to the heart means that the blood is pumped at a higher pressure than normal into the lungs. The excess pressure weakens the heart and damages the lungs. 

In the most serious cases, the damage to the heart and lungs may be untreatable and a Heart-Lung Transplant will be required. 

Primary pulmonary hypertension 

Primary pulmonary hypertension is a rare condition where, for unknown reasons, the blood pressure within the lungs is much higher than usual. Over time, the excess pressure can weaken the heart and then damage the lungs. 

Cystic fibrosis 

In cases of cystic fibrosis, a thick sticky mucus develops inside the lungs which can damage them. 

Cystic fibrosis can often be successfully treated using a lung transplant, but there may be some circumstances where if a donated set of heart and lungs are available, a Heart-Lung Transplant will be performed. 

If the blood supply that connects the heart to the lungs becomes damaged, it is more likely that transplanting both the heart and the lungs will be successful. 

There is also the additional benefit that the original heart, which is usually undamaged except for the nearby blood vessels, can be used as a transplant organ for somebody else. This is known as a ‘domino transplant’. 

As a result of the lack of available donor organs, transplant teams have to assess potential recipients very carefully. They need to establish whether there are problems or factors, that may result in the donation proving unsuccessful. The outcome of the assessment may mean that the risks of a Heart-Lung Transplant outweigh the benefits. 

Absolute contraindications 

Absolute contraindications for a Heart-Lung Transplant include: 

• being over 65 years of age and having another serious health condition 
• having blood poisoning (septicaemia) 
• having an incurable form of cancer 
• currently misusing alcohol or drugs 
• currently smoking, or 
• having a mental health condition, such as schizophrenia, that means you are highly unlikely to comply with the treatment that will be required during the recovery period, such as taking immunosuppressant medication 

Relative contraindications 

Relative contraindications for a Heart-Lung Transplant include: 

• having HIV 
• having hepatitis B 
• having hepatitis C 
• being obese 
• having severe diabetes that has caused damage to your organs, or 
• having severe osteoporosis (brittle bones) – as many of the medications that are used in the recovery period can weaken bones, they are usually unsuitable for people with severe osteoporosis 

Further assessment 

As part of your assessment, you may have some of the tests that are described below. 

• blood and urine tests – to check for viral or bacterial infections, as well as assessing the state of organs, such as your kidneys and liver 
• chest X-rays 
• blood pressure tests 
• lung function test – where a machine called a pulse oximeter is used to measure the amount of oxygen that is in your blood 
• computer 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 – a special type of X-ray that can be used to study the inside of your heart 
• electrocardiography (ECG) – a test that can measure the electrical activity of your heart 

After the transplant 

Following your Heart-Lung Transplant, it is likely that you will have to stay in the Intensive Care Unit (ICU) for several days. There are several reasons for this: 

• Your new organs will be very vulnerable to infection immediately after the transplant, so you will need to stay in a sterile (germ-free) environment. 
• There is a risk that your body may reject the heart and/or the lungs, which would require emergency treatment. 
• You will require additional assistance with breathing and feeding until you begin to recover. 

You will be given pain relief as required both at this stage (when you are less mobile) and as you recover and begin to move around the ward. 

You will then usually be transferred to a general ward within 3 to 4 days where your health will continue to be monitored as you recover from the effects of the surgery. Most people will be well enough to leave the hospital within 3 weeks of having a Heart-Lung Transplant. 

The recovery process 

Recovering fully from a transplant is a long-term process. You may be referred to a physiotherapist so that you can take part in exercises that are specifically designed to strengthen your new heart and lungs. This is known as cardiopulmonary rehabilitation. 

During your recovery period, you will need to attend regular check-ups so that the function of your new heart and lungs can be regularly monitored. You may need as many as 3 check-ups a week during the first few weeks after the transplant. These appointments will become less frequent if you make good progress. 

After having a Heart-Lung Transplant, it may take several months before you are well enough to return to your normal daily activities. 

Once you make a full recovery, you will still require regular check-ups on a long-term basis.  

Immunosuppressants 

After having a Heart-Lung Transplant, one of the biggest risks is that your immune system will regard the new heart and lungs as foreign objects and begin to attack them. This is known as rejection.  

To prevent your new heart and lungs from being rejected, you will need to take medicines, known as immunosuppressants, to suppress your immune system. Immunosuppressants work by interfering with the normal activities of specialised white blood cells called T cells. 

The immune system uses T cells to kill foreign cells, such as bacteria, viruses and, in the case of transplants, donated tissue, such as your new heart and lungs. 

If you respond well to treatment, the doses of immunosuppressants may be lowered over the long term. 

Immunosuppressants are powerful medicines that can have a range of different side effects. Possible side effects you may experience include: 

• increased vulnerability to infection 
• weakened bones (osteoporosis) 
• muscle weakness 
• nausea 
• vomiting 
• stomach ulcers 
• blurred vision 
• insomnia 
• weight gain 
• mood swings 
• shaking of the hands 
• acne 

While these side effects may be troublesome, you should never stop or reduce the recommended dose of immunosuppressants, because if you do, it could lead to your heart and lungs being rejected. 

The transplant centre may be able to provide additional treatments to help you cope better with any side effects that you experience after taking immunosuppressants. 

Risks following a Heart-Lung Transplant

One of the biggest risks after having a Heart-Lung Transplant is that, despite taking immunosuppressants, your body will reject the new heart and lungs. 

There are 2 types of rejection: 

• acute rejection – where rejection occurs just after surgery 
• chronic rejection – where rejection occurs many months or years after surgery 

Signs that your body may be rejecting your heart include: 

• fatigue 
• swelling of your arms and legs 
• weight gain 
• a high temperature (fever) of above 38C (100.4F) 

Signs that your body may be rejecting your lungs include: 

• cough 
• shortness of breath 
• difficulties breathing 
• a high temperature (fever) of above 38C (100.4F) 

If you have any of these symptoms, you should contact the doctor as soon as possible. 

Rejection can usually be treated by increasing the dose of your immunosuppressive medicines. 

Infection 

The immunosuppressant medicines will weaken your immune system making you more vulnerable to infection. 

The 3 most common types of infection experienced by people who have undergone Heart-Lung Transplants are: 

• bacterial infection 
• fungal infections 
• cytomegalovirus (CMV) infection 

Preventing long-term infection 

After having a Heart-Lung Transplant, you will likely need to take immunosuppressants for the rest of your life because you will be more vulnerable to infection. This means that you will have to take extra precautions that most people are not required to take. These include: 

• avoiding crowds – if this is unavoidable, you should wear a face mask, particularly during the first year after your transplant 
• avoiding close contact with anyone who is known to have an infection 
• avoiding anything that could damage your lungs and make them more vulnerable to infection, such as smoke, chemical sprays or chemical fumes 
• keeping your house very clean to prevent the spread of infection 

Transplant success rate 

Data shows that: 

• 66% of people will survive for 1 year after receiving a Heart-Lung Transplant
• 63% of people will survive for 2 years after receiving a Heart-Lung Transplant
• 47% of people will survive for 5 years after receiving a Heart-Lung Transplant
• 36% of people will survive for 10 years after receiving a Heart-Lung Transplant