Heart-lung transplant is a treatment for people with very serious lung and heart problems. It is done on both adults and children. This includes various diseases of the lung tissue itself, including cystic fibrosis. The first successful heart and lung transplant was done at Stanford University in 1981. Since then, many advances have been made. Early failures were due to infection, breakdown at the junction in the windpipe (trachea), poor function of the transplanted organs and rejection of foreign tissue. These are now much less of a problem.

Why it should be done

This operation is done to save the lives of people who have severe damage both to the heart and to the lungs. Often the heart damage is the result of a rise in the resistance to blood flow though the lungs. This can result from conditions such as chronic bronchitis, emphysema, silicosis and asbestosis. (This is called cor pulmonale.)

When it should be done

The timing of the operation depends on the quality of life of the person with the heart/lung problem. It also depends on how fit the person is for surgery, and on the availability of compatible donor organs.

How it is performed

The donated heart and lungs come from a healthy donor who has just died. The heart and lungs must be transplanted as soon as possible after death - preferably within four hours. A heart-lung machine is set up. This takes over the function of the heart and lungs by keeping blood flowing around the body, putting in oxygen and taking out carbon dioxide. The damaged heart is removed first. This makes it easier to remove the damaged lungs and to avoid damage to the essential nerves that control the breathing muscles.

The main artery to the body (aorta), the main returning veins and the windpipe are then reconnected.

Recovery

The main problems affecting recovery are infection and bleeding immediately after the operation. Next is the problem of rejection. The body recognises the new heart and lungs as foreign tissue and mounts an immune response, trying to destroy them. Immunosuppressant drugs have to be taken for life to prevent this reaction. Techniques of surgery and new ways to control or prevent rejection are developing all the time, and the results from this operation will continue to improve.