Lung Transplantation

Your own physician will make a referral for you to be evaluated for whether a transplant may be appropriate at Ohio State’s Wexner Medical Center. Here are some of the steps in the pre-transplant referral process:

1. The referring physician or other provider is responsible for providing the coordinator with all applicable medical information according to the transplant referral protocol provided at time of referral. This information is shared with physicians on the transplant team to see if testing for potential transplant listing should be scheduled
2. We will verify your coverage for initial testing with your insurance company before making your initial evaluation appointment. Our pre-transplant office and hospital business office will work with you to determine insurance availability and precertification requirements
3. Pre-transplant coordinators and business office staff then work together to meet insurance company requirements for evaluation and transplant procedure approval 

Changing harmful habits should be a priority, as our program does not consider patients who are current smokers or alcohol- or drug-dependent. Potential recipients must be substance-free for at least six months before being listed for transplant. We will perform random testing, and a positive test could result in your removal from our list.

During your first appointment, you will meet your transplant team and be scheduled for evaluation testing at Ohio State’s Wexner Medical Center. A full outpatient clinic evaluation will determine whether listing for transplant would be an appropriate option for you.

The evaluation includes extensive pulmonary and cardiovascular testing, multiple tests that evaluate general health, lab work, education, surgeon and pulmonologist evaluations and a social work consultation. Transplant candidates must be in good overall health, since the surgery is difficult and medications taken after transplant are very hard on several body systems including bones, kidneys and liver.

You may also have consultations with a transplant infectious disease specialist (if needed) and other professionals who may be appropriate to your condition.

Every patient moving forward with testing for lung transplant will also have a psychosocial assessment with a social worker. This evaluation will help determine if you have the mental stability, motivation and personal support to meet the challenges of transplantation.

Patients will take part in a comprehensive education program that details the surgical procedure, medications, recovery and rehabilitation associated with the transplant process.

It is preferred that these tests be completed at Ohio State’s Wexner Medical Center, but depending on your geographic location or payer preference, they may be completed closer to your home. Ask your coordinator if this is an option for you.

Transplant physicians send follow-up letters to the referring physician summarizing the pre-transplant clinic visit and any additional information required. Once the evaluation is complete, we submit the clinical data received for insurance authorization.

The transplant team evaluates the information gathered and determines whether transplantation is appropriate. We will also determine what additional information is needed prior to placing you on the transplant list. Once the evaluation is complete, your coordinator will present your case to The Ohio State University Wexner Medical Center Patient Selection Committee for approval.

Patients are not actively listed for transplant until insurance approval is received. Once approved, you are then listed for lung transplantation on the United Network for Organ Sharing (UNOS) national waiting list.

For Medicaid patients only, additional approval is also needed from the Ohio Solid Organ Transplantation Consortium (OSOTC).

Your wait time can depend on factors such as your blood type, body size and the severity of your illness. The wait time could be from days to years.

You should always be within a three-hour drive of Columbus, due to tight time constraints of a transplant.

You will receive instructions on when to arrive to the medical center, where to register once you arrive, when to stop eating and drinking, and any other important information. 

You will undergo lab tests, receive an x-ray and begin immunosuppression medications. You will then go to surgery. You will be in the operating room for several hours, depending on individual circumstances, including whether you are receiving a single or double lung transplant.

Upon completion of the surgery, you will be closely monitored in an intensive care unit for complications. You will be on a ventilator with multiple IVs and monitoring devices. Usually, you will be weaned from the ventilator and out of bed within a day or two of your operation. The average length of stay for a lung transplant patient is two to three weeks, but can be shorter or longer.

You will be seen daily by the transplant team. You’ll receive individualized education at the bedside from a lung transplant coordinator on medication and general discharge instructions. An advanced practice provider will coordinate your care process, communicate with insurance case managers and plan for discharge. A social worker will visit you to address any psychosocial issues associated with the transplant.

Once you are discharged, you will have a number of appointments for follow up care. Be sure to keep all of your appointments.

You should plan to have appointments with your care team on a schedule that will progress like this:

After Surgery, Follow Up Care (first year post transplant):

• Once a week for 4 weeks, then
• Every 2 weeks for 1 month, then
• Once a month for 9 months

Lab Work:

• Twice weekly for 4 to 6 weeks, then
• Weekly for 6 months, then
• Every 2 weeks for months 6 to12
• Monthly after 1 year

Bronchoscopies:

• On months 1, 3, 6, 9, 12 (this may change based on your condition and the results from the previous bronchoscopy)
• None after the first year unless you are having issues

Spirometry:

• You will also have Spirometry every month for life

We will communicate with your referring physician at the beginning and end of each hospitalization, as well as each outpatient clinic visit.

Taking care of your new lungs can determine your success after transplant. Maintaining a healthy lifestyle and changing harmful habits should be priorities. We expect our patients to participate in pulmonary rehabilitation. Lung transplant recipients who return to smoking will not be considered for re-transplant.

This doctor who specializes in transplants will follow you before and after your transplant. They will complete a physician exam and discuss with you what additional tests are needed for you to receive a transplant.

This doctor will perform your lung transplant surgery and help take care of you after the transplant. They will discuss the operation and responsibilities after transplant. 

This doctor specializes in heart care and will follow you before, during and after your lung transplant to ensure your heart stays healthy throughout the process.

These doctors, who specialize in infectious diseases, will follow you before and after your transplant (if needed) to reduce risk of infection.

The advanced practice providers include physician assistants and nurse practitioners who work closely with your physician to ensure continuity of care throughout your stay at the hospital and your transition to outpatient care. They order and monitor diagnostic tests and treatments, respond to urgent needs, diagnose and treat problems if they arise and provide the educational tools and resources necessary to continue success with your transplant once you are discharged.

Transplant coordinators are nurses who will be your primary contact before and after your transplant. Coordinators help answer any questions you may have from the time you walk into the medical center through your recovery and continued care.

These professionals meet with you to evaluate your psychological readiness for transplantation.

A transplant pharmacist is a pharmacist who specifically works with patients who have received a transplanted organ. This pharmacist has been trained to understand details about anti-rejection medications, works closely with your transplant physician to help manage your medications and helps answer medication questions you may have.

The pharmacy patient assistance coordinator offers assessment, linkage and referrals for assistance to patients who need certain medications and have high co-pays or no prescription drug coverage.

Contact: 800-626-2538

This individual will review your insurance benefits prior to the evaluation and transplant process and assist you and your family with insurance questions or concerns.

Patient Care Associates (PCA) are staff members who take patients to their rooms, gather vital signs and perform other patient care duties in the outpatient clinic setting.

Office Associates help in scheduling and other clerical responsibilities.

The list of accepted insurances for lung transplant can often change. Please contact your health care insurance provider to confirm your coverage for transplant at Ohio State’s Comprehensive Transplant Center.

Ohio State's Tissue Typing Laboratory ensures that an organ is compatible with its recipient. The process involves matching a person's unique configuration of six human leukocyte antigen (HLA) molecules with a potential pool of approximately 100 different varieties.

Cross-match testing helps prevent some types of organ rejection. The testing involves mixing cells from the donor's and recipient's serum to determine whether rejection-promoting antibodies will occur. This information helps your physicians plan for the right medication strategy to best control organ rejection.

Transplant support testing includes monitoring new drugs that patients use, testing to determine a patient's overall ability to maintain a recipient's organ and developing new tests to support many of the clinical aspects of transplantation.