WHAT IS LUNG TRANSPLANTATION?

Lung Transplantation is a surgical procedure in which the failing lung of a patient with advanced lung disease is replaced with a healthy lung from a recently deceased, brain-dead donor. In rare cases, part of a lung can be taken from a living person for lung transplantation.

WHO CAN BENEFIT FROM LUNG TRANSPLANTATION?

Patients are considered potential candidates for lung transplantation if they have severe, symptomatic and progressive lung disease that is refractory to conventional therapy, with an estimated life expectancy of less than 18 months despite optimal medical therapy.

Common causes of advanced lung disease in Singapore include:

• Chronic obstructive pulmonary disease/ emphysema
• Interstitial lung disease (e.g. idiopathic pulmonary fibrosis - refer to Figure 1)
• Bronchiectasis
• Pulmonary hypertension (primary and secondary)

Following a successful lung transplantation, these patients can expect to have an improved quality of life and increased long-term survival.

Due to breathing difficulties, pre-lung transplant patients often have severe limitations in their activities of daily living, and they are also frequently admitted into the hospital for exacerbations of their underlying lung disease.

After lung transplantation, these patients are able to return to their normal lives. They are able to exercise, work and travel after a period of recovery from their operation, without many of the previous restrictions.

Worldwide, the one-year survival rate post-transplantation is 80% to 90%, and the five-year survival rate post-transplant is over 50%. These figures have improved over the years and the out- Services look is expected to improve further with advances in lung transplantation.

EVALUATION FOR LUNG TRANSPLANTATION

Our multidisciplinary team of pulmonologists, thoracic surgeons, clinical coordinators, psychiatrists, dieticians, physiotherapists and medical social workers will meet each referred patient and review his or her medical records to determine the suitability for lung transplantation.

If the patient is found to be a suitable transplant recipient, a comprehensive pre-transplantation work-up consisting of blood, sputum and urine tests, chest X-ray, Computed Tomography (CT) scans, bone mineral densitometry, radionuclide studies, lung function testing, echocardiogram, as well as cardiac catheterisation, will be performed.

Following the evaluation, if the patient meets all the qualifying criteria for lung transplantation, he or she will be placed on a waiting list for the transplant. If a suitable donor is found, the patient will undergo the transplant operation to have either one (single lung transplantation) or both (bilateral lung transplantation) lungs replaced.

LUNG TRANSPLANTATION IN SINGAPORE

National Heart Centre Singapore (NHCS) is the only institution in Singapore that performs lung transplantation.

A total of 13 lung transplants have been done since the inception of the lung transplantation programme in 2000. Most of the transplants were carried out for patients with chronic obstructive pulmonary disease (54%) or interstitial lung disease (38%).

NHCS’s clinical outcomes for lung transplant recipients are comparable with those reported internationally, with a one-year survival rate of 83.3% and a five-year survival rate of 50% for the period of 2006 to 2016.

However, the average waiting time on the waiting list was 447 days, as there is generally a low consent rate for lung donation.

Lung donation is not covered by the Human Organ Transplant Act (HOTA), unlike the cornea, kidneys, liver and heart. Thus, if the deceased donor had not given his or her consent to donate his or her lungs, or other organs, prior to his or her demise, or there was no consent from the relatives after the declaration of the donor’s brain death, the lung or other organs cannot be recovered for the purpose of transplantation.

How do I refer a patient for consideration for lung transplantation?

For more information on the NHCS lung transplant programme, or if you wish to refer a patient for consideration for lung transplantation, please contact:

Clinical Coordinator
Mechanical Circulatory Support, Heart and Lung Transplant Unit
National Heart Centre Singapore
5 Hospital Drive
Singapore 169609
Tel: 6704 8130
Email: transplant.office@nhcs.com.sg

OUR LUNG TRANSPLANT PROGRAMME TEAM