Lung Transplant Services at University Hospitals

Your pulmonologist may refer you to our program for evaluation, or you may contact us directly.

Once we receive your referral, a lung transplant coordinator will call you to complete an intake to get more information and schedule you for your first visit with our medical director.

This phase is a great time to prioritize healthy habits like maintaining a healthy weight, staying nicotine-free, participating in pulmonary rehabilitation and identifying support people.

The evaluation phase takes about two weeks to complete. Our team will assist you with scheduling all aspects. It is a good idea to bring a support person with you during these appointments.

In your initial visit, you will meet with:

• One of our lung transplant pulmonologists, for review of your medical history, current functional status and possible candidacy for lung transplant.
• Lung transplant coordinators, who will provide an in-depth education session outlining detailed information about lung transplant.
• A licensed social worker to complete a psychosocial assessment and help you with more complex support needs throughout your journey.

A detailed evaluation also involves tests to assess your lung, heart and kidney function, as well as overall health status. Diagnostic testing includes:

• Blood work
• Heart catheterization
• Pulmonary function tests
• Six-minute walk test
• Chest CT scan or x-ray
• Colonoscopy
• Dental exam
• Nutrition evaluation
• Mental health evaluation
• Financial review and insurance authorization

You will then meet with a lung transplant surgeon for evaluation and recommended surgical technique.

Following these steps, our selection committee will review all test and evaluation results together to determine if a lung transplant is the best option for you.

If you are deemed an appropriate candidate for lung transplant, you will sign a consent form to be listed with the United Network for Organ Sharing (UNOS) list. A listing score is created based on your unique clinical presentation, not when you joined the list.

Note: Lung transplant candidates who previously smoked must remain nicotine-free for six months before being put on the UNOS transplant list.

During this phase, our medical and surgical directors will review all received offers for you to ensure the best possible fit. Your time on the UNOS waitlist is highly variable based on many factors, including your blood type, body size and disease process. You will be given a Lung Composite Allocation Score (CAS), which we will routinely update. We will continue to see you monthly for regular appointments while you are listed.

It is imperative that you are always reachable. Because an offer for an organ can come at any time, we must be able to reach you. You will need to have reliable transportation to UH Cleveland Medical Center immediately once an offer is received.

You and our team must always remain in open communication. We must be notified if you are traveling further than one hour from home, are hospitalized for any reason, have a change in your overall health, or have a change in insurance.

You must maintain your healthy behaviors, such as staying nicotine-free, continuing pulmonary rehabilitation, and maintaining a healthy weight during the listing phase. Changes to these behaviors could cause you to be removed from the UNOS waitlist.

You must be within a one-hour radius of UH Cleveland Medical Center. You will receive a phone call when you have an organ match. Do not eat or drink anything as soon as you have been notified.

You and your support person will immediately come to UH Cleveland Medical Center, where you will be admitted to the Cardiothoracic Intensive Care Unit (CTICU) while the organ is transported by the organ procurement team.

Our team will complete a final visualization of the organ before giving the actual go ahead. Once it is known with absolute certainty that we are proceeding with lung transplant, you will be brought to the operating room and prepared for surgery. Surgery will take several hours.

There is a possibility of a “dry run.” A dry run is an organ offer that does not lead to transplant. An offer may come that is a good fit for you, but on visual inspection of the lungs by our team, it is determined that it is not suitable. A dry run does not impact your standing on the UNOS national waitlist and does not impact any future offers.

You will be in the hospital for at least three to four weeks after your transplant. You will stay in the CTICU for the first several days, where you may need a ventilator to support your new lungs, intravenous (IV) medications to support your heart and blood pressure, and other special equipment.

When you are ready, you will move to a step-down unit or nursing floor. During this phase, you will receive further education from our lung transplant coordinators and pharmacists about your medications and life after transplant.

During your hospital stay, you will have daily blood work, chest x-ray and may require additional testing.

The lung transplant team will see you every day during your hospitalization, and you will always be at the center of your care team. When it is time for your discharge from the hospital, we will work closely with you and your loved ones to ensure that:

• Your medications are available.
• Your appointments are scheduled.
• You are confident in your medication regimen.
• You feel safe and ready to return home.

You will be cared for by our lung transplant team for life after transplant. Appointments and testing will be frequent in the first few months following transplant then gradually decrease as you are further out from surgery and more recovered. Aspects of follow-up care include:

• Office visits – twice a week for at least two weeks, then gradually less often based on your personal case
• Blood work – weekly
• Surveillance bronchoscopy – the first performed two to three weeks after surgery, then every two months the first year and every three months the second year
• Chest X-ray – weekly
• Spirometry – weekly