Key points
- The lung transplant active list is not like a regular waiting list. The lungs don’t go to the person waiting the longest, they go to the sickest person that the lungs would match.
- When comparing the donor lungs to patients on the list, there may be a number of suitable matches. The team will then consider how sick the patients on the list are, to decide who to call in for potential surgery.
- Sometimes a patient has a match within months, but it can take years. Sadly, some patients will die before a suitable match is found.
- You will be added to the single lung transplant list, the double lung transplant list, or both, depending on your needs.
What is the active list?
The active list is a list of all patients currently suitable for and ready to receive a lung transplant. When donor lungs become available, the transplant team considers all suitable patients on the active list to find the best match.
What makes a good match?
To give the transplant the best chance of success, the lung(s) should be a similar size to your own. The team will also consider blood group and the results of antibody tests.
When comparing the donor lungs to patients on the list, there may be a number of suitable matches. The team will then consider how sick the patients on the list are to decide who to call in for potential surgery.
How do lungs become available?
Sometimes, when a person dies, it may be possible for them to donate their organs (for example, lungs, heart, kidneys, liver, pancreas) to other people. The person must have died in a hospital while on a breathing machine, and they must meet other medical rules. Each person 18 years or older in Ireland is considered a potential organ donor when they die, unless they specifically opt out.
The person’s family will always be consulted before moving forward with organ donation. If they agree to donation, the transplant team will decide based on the donor's past medical history and how the lungs are working now, if the organs are suitable for transplant.
You can learn more about organ donation from the HSE.
Donors who have smoked
You may receive a transplant from a donor who smoked. These lungs are carefully assessed. Only lungs that are healthy and working well are considered for transplant. Accepting lungs from donors who smoked increases the number of lungs available to transplant, shortens waiting times and reduces the risk of becoming too sick for lung transplant.
Augmented risk donors
Due to a global shortage of organ donations and a rise in successful antiviral therapies, the transplant team offers donations from augmented risk donors. These are donors who are overall healthy but might have certain risk factors that slightly increase the chance of getting an infection from them. Before joining the active list, you will need to decide whether you would accept lung(s) from an augmented risk donor.
All donors are tested for infections before transplant. However, there is a window period during which a donor could have gotten a new infection that does not show up on blood tests, leading to a small risk of transmission. This includes viruses such as Hepatitis B, Hepatitis C and HIV.
If you consent to being matched with lung(s) from an augmented risk donor and you receive a call that lung(s) have come available, the team will let you know if they are from an augmented risk donor. You'll need to provide consent once more before the surgery can go ahead.
To learn more, go to Augmented risk donors.
How long will I be waiting?
The lung transplant active list is not like a regular waiting list. The lungs don’t go to the person waiting the longest, they go to the sickest person who matches the lungs, based on size, blood group and antibodies. This means that it is very difficult to predict how long you will be waiting. Not every lung will suit every patient on the active list. People who are very short or very tall or have lots of antibodies are likely to wait longer. You will also likely wait longer if you need a double lung transplant, rather than single.
Sometimes it happens within months, but it can take years. Sadly, some patients will die before a suitable match is found. It is important to talk to your family and loved ones about this possibility.
Single vs. double lung transplants
The transplant team discuss everyone's case independently to help make the right decision for you. You will be either added to the single lung transplant list, the double lung transplant list, or both. The decision depends on several factors including:
Single lung transplants
In single lung transplants, only one diseased lung is replaced by a healthy donor lung. The new lung becomes your primary lung for breathing, while the old lung loses function over time.
A single lung transplant might better for patients
- with COPD
- with pulmonary fibrosis
- who are older
- who have other health conditions that make a longer surgery riskier
The advantages of a single lung transplant include
- shorter operation time
- could be lower risk for some older patients
Double lung transplants
A double lung transplant replaces both lungs. For some conditions, this is necessary, including:
- Cystic Fibrosis
- Bronchiectasis
- Pulmonary arterial hypertension
Patients with COPD or pulmonary fibrosis may also benefit from a double lung transplant, depending on their medical history.
The advantages of a double lung transplant include
- lower risk of infection spreading from old lung
- improved long term lung function and exercise capacity
- better long term survival (60-70% after 5 years)
Patients who need a double lung transplant may need to wait longer to find a suitable match.