Lung Transplant Surgery

When a compatible donor lung is found, you will be notified by a member of the transplant team. At that time, you will be given instructions about coming to the hospital for your transplant.

Once you have been checked in at the hospital, you will be taken to the operating room. There, you will receive general anesthesia and be put to sleep. You may be placed on a heart-lung machine (cardiopulmonary bypass) that will handle the functions of your heart and lungs while the surgeon is working on both your old and new lungs. You will also have a breathing tube in your throat, called an endotracheal tube. This tube is connected to a machine called a ventilator, which will breathe for you during and after the operation.

If you are having a single lung transplant, you will have a thoracotomy incision either on your right or your left side, depending on which lung is being replaced. After the donor lung arrives in the operating room, the surgeon will remove your diseased lung. You will be ventilated using your other lung. If your remaining lung is not able to exchange enough oxygen, the surgeon may place you on cardiopulmonary bypass. Your blood will be filtered through a machine outside your body which will oxygenate your blood and remove carbon dioxide.

Three connections will be used to attach your new lung. These connections are called anastomoses. First, the main bronchus from the donor lung is attached to your bronchus. Then the blood vessels are attached, along with the pulmonary artery and the pulmonary veins. Finally, the incision is closed and you will be taken to the intensive care unit, where you will be asleep for approximately 12 to 24 hours.

If both your lungs are transplanted (a bilateral transplant) the surgeon will make an incision below each breast, called an anterior thoracotomy, or an incision that goes from your right side to your left side at the base of your breasts. This is called a transverse sternotomy incision. In a bilateral lung transplant, each lung is replaced separately. The surgeon begins by removing the lung with the poorest function. You will be ventilated using your remaining lung unless partial cardiopulmonary bypass is needed. Once your first lung is removed, a donor lung will be attached using three connections. The donor bronchus is attached to your main bronchus first, and then the blood vessels are attached, first the pulmonary artery, then the pulmonary veins. Your second diseased lung is then removed, and the other new lung is attached just like the first one. Once the second lung is completely connected, blood flow is restored. Finally, your incision is closed and you are taken to the intensive care unit (ICU).


After surgery, you will go to the cardiothoracic surgery intensive care unit (ICU) where a doctor and nurses are always very close by if you need anything. At first, you will be under the effects of anesthesia. You will have many IVs, special tubes and initially a breathing tube. Once you wake up and breathe on your own, the breathing tube will be removed. With either incision, nerves can be cut resulting in various degrees of decreased sensation.

Various tubes and equipment will be used to monitor how well your lungs and body are recovering after surgery:

  • IVs (intravenous tubes) will help you receive fluids and medications. A special IV called a pulmonary artery catheter (Swan Ganz catheter) in your neck vein will measure the pressures in your heart and lungs and tell the surgeon how well your new lungs are functioning.
  • A heart monitor will record your heart rate and rhythm at all times.
  • Tubes in your chest near the bottom of your incision and possibly on the sides of your chest will drain the blood and fluid that collect in your chest after the operation. They are usually removed several days after the surgery.
  • A small tube, called a foley catheter, in your bladder will help us measure how well your kidneys are working. This tube will be taken out a couple of days after your surgery, and then you will urinate on your own.
  • An epidural catheter may be placed to manage your pain. Later you will receive IV pain medication that you dose yourself through a special patient-controlled analgesia (PCA) device.

A typical stay in the ICU is three to seven days. You will then be transferred to the thoracic surgery floor where our nurses and physical therapists will help you regain your strength, teach you how to care for yourself when you go home, and prepare you for discharge from the hospital. If all goes well, you can expect to spend one to two weeks on the thoracic surgery floor before your discharge. You may be asked to stay at the Mason Guest House or other local housing facility for general needs after discharge from the hospital.