Lung transplant surgery replaces one or both diseased lungs with healthy donor lungs when advanced lung disease has significantly affected breathing and other treatment options are no longer enough. If you are preparing for a transplant, knowing what happens during the operation can make the process feel more understandable and less unfamiliar.
The surgery involves several carefully coordinated steps, from preparing you under general anaesthesia to removing the diseased lung, connecting the donor lung to your airway and blood vessels, and monitoring the new lung before you are transferred to the intensive care unit.
Before discussing the operation itself, it is useful to understand lung transplant surgery as a whole, including when it may be considered, the evaluation process, and what recovery involves.
What Happens Before Lung Transplant Surgery?
Once a suitable donor lung becomes available, the transplant team contacts the recipient and asks them to come to the transplant centre. There are several final checks before surgery begins.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
These may include blood tests, imaging, physical assessment and other investigations to confirm that you are fit to undergo the operation and that there are no new concerns that could affect the transplant.
The donor lung is also assessed to determine whether it is suitable for transplantation. If everything is considered appropriate, preparations for surgery begin.
Are You Awake During a Lung Transplant?
No. Lung transplant surgery is performed under general anaesthesia, so you are completely unconscious during the operation.
A breathing tube is placed into your airway and connected to a ventilator. The anaesthesia team continuously monitors your breathing, blood pressure, heart rate, oxygen levels and other important functions throughout the procedure.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Several intravenous lines, monitoring devices and catheters may also be placed before or during surgery to allow the medical team to give medicines and fluids and closely monitor your condition.
How Is the Diseased Lung Removed?
The surgical team makes an incision in the chest to reach the lung that is being replaced. The exact surgical approach depends on whether you are receiving a single-lung or bilateral lung transplant and on your individual circumstances.
The diseased lung is carefully separated from the surrounding structures. The major connections between the lung and the body are identified and divided so that the damaged lung can be removed safely.
These connections include:
- The main airway, or bronchus
- The pulmonary artery
- The pulmonary veins
How Is the Donor Lung Connected?
The donor lung is placed into the space previously occupied by the diseased lung. The surgeon then carefully connects the new lung to the recipient's airway and blood vessels.
The main connections are made between the donor and recipient:
- Bronchus, which carries air to and from the lung
- Pulmonary artery, which carries blood toward the lung
- Pulmonary veins, which return oxygenated blood to the heart
These connections need to be secure and properly aligned so that air can move through the airway and blood can circulate through the transplanted lung.
What Happens When the New Lung Is Connected?
After the donor lung has been connected, the surgical team gradually restores blood flow to it. The lung is then ventilated so that it can expand and begin functioning.
The team closely observes the transplanted lung and the patient's overall condition. They check that the airway and blood vessels are functioning as expected and monitor oxygenation and circulation.
The new lung may begin functioning within a relatively short period after transplantation, although the immediate postoperative period involves close monitoring because the body and the transplanted lung are adjusting to each other.
Is a Heart-Lung Bypass Machine Used During Lung Transplant?
Not every patient requires mechanical support during lung transplantation. However, some patients may need temporary support to maintain blood circulation and oxygenation while the surgical team works on the lungs.
Depending on the patient's condition and the complexity of the procedure, the team may use cardiopulmonary bypass or extracorporeal membrane oxygenation (ECMO).
These systems can temporarily support the heart and lungs during parts of the operation when normal circulation or oxygenation needs additional assistance.
The decision to use this support depends on factors such as the patient's condition, the type of transplant and how well the body tolerates the procedure.
What Happens During a Double Lung Transplant?
In a bilateral or double lung transplant, both diseased lungs are replaced with donor lungs. The surgeon generally removes and replaces one lung before proceeding to the other.
The new lungs are connected to the recipient's airway and blood vessels in the same basic manner as a single-lung transplant.
Because both lungs are being replaced, the operation is more extensive and requires careful coordination throughout the procedure. The exact sequence may vary depending on the patient's condition and the surgical team's approach.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
How Is the Chest Closed After Lung Transplant Surgery?
Once the surgical team is satisfied with the position and function of the transplanted lung, the surgical area is closed.
Chest drains are usually placed to remove blood, fluid and air that may collect around the lungs during the early recovery period. These drains help the medical team monitor and manage the chest as healing begins.
The incision is then closed, and the patient is transferred to the intensive care unit for close postoperative monitoring.
How Long Does Lung Transplant Surgery Take?
The length of lung transplant surgery varies from person to person. The procedure can take several hours, with the exact duration depending on whether one or both lungs are being transplanted, the patient's medical condition, and whether additional support is required during surgery.
Double lung transplantation generally takes longer than a single-lung transplant because both lungs need to be removed and replaced.
It is important to remember that the total time spent at the hospital or operating area can be longer than the surgical time itself because of preparation before the operation and immediate postoperative care.
How Does Recovery Begin After Lung Transplant Surgery?
Recovery does not end when the operation is completed. Once you are medically stable, the focus shifts toward regaining strength, improving breathing and gradually becoming more independent.
Physical activity is introduced progressively. You may work with physiotherapists and other members of the transplant team to improve mobility, breathing and overall physical conditioning.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Your recovery time depends on factors such as your health before transplantation, the type of transplant you received, your response to surgery and whether any complications occur.
What Are the Main Risks During or After Lung Transplant Surgery?
Lung transplantation is a major operation, and complications can occur during or after surgery. The risks vary according to your underlying disease, overall health and the type of transplant performed.
Possible complications may include:
- Bleeding
- Infection
- Problems with the transplanted lung functioning immediately after surgery
- Blood vessel or airway complications
- Rejection of the transplanted lung
- Complications related to immunosuppressive medicines
The Bottom Line
Lung transplant surgery is a carefully coordinated procedure that involves removing a diseased lung and replacing it with a healthy donor lung. The new lung is connected to the airway and major blood vessels, and its function is checked before the chest is closed.
Whether you receive a single or bilateral transplant, the operation is only the beginning of the transplant journey. Intensive monitoring, medicines, rehabilitation and long-term follow-up all play important roles in recovery and in protecting the transplanted lung.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Understanding each stage of the surgery can help you know what to expect and prepare more confidently for discussions with your transplant team.
