Abstract
The lungs are essential for life as they help us breathe fresh air. The lungs absorb oxygen and supply it to the cells and tissues, while removing carbon dioxide from the body. Sometimes diseases can damage the lungs, and they can no longer support the body’s needs. If the lungs cannot recover, a surgery to replace the sick lungs with new, healthy lungs becomes necessary. This surgery is called a lung transplant. The new lungs come from a healthy donor who has passed away. Donors and their families choose to provide an amazing gift—a second chance at a healthy life for the patient receiving the new lungs. After a lung transplant, patients must take medicines for the rest of their lives to keep the new lungs healthy. However, thanks to the kindness of donors and their families, patients can lead healthy, normal lives and return to activities they love!
Your Lungs Give You Fresh Air
You have two lungs that help you breathe. They are connected to the air outside your body through a tube called the trachea, which splits into two smaller tubes called bronchi—one goes to each lung. The right lung is a bit bigger and has three parts, called the upper, middle, and lower lobes. The left lung has just two lobes: the upper and lower lobes. Between the two lungs is the heart. The lungs and the heart work closely together. They are connected by important blood vessels called the pulmonary artery and pulmonary veins.
Every part of your body needs oxygen to stay alive and gives off a gas called carbon dioxide as a waste product. Your lungs take oxygen from the air and pass it into your blood. Special blood cells, called erythrocytes, carry oxygen with the help of a protein inside them called hemoglobin. The oxygen-rich blood goes to your heart, which pumps it to the rest of your body. When the blood reaches the various body parts, it drops off oxygen and picks up carbon dioxide. Then, blood travels back to the heart and lungs through the pulmonary artery, where it releases carbon dioxide and gets fresh oxygen again. This amazing teamwork keeps your body working (Figure 1)!
- Figure 1 - The heart and lungs.
- The blue arrows show carbon dioxide-rich blood leaving the heart and arriving to the lung through the main pulmonary artery. The red arrow shows oxygenated blood arriving from the lung to the heart. Important structures include: (1) upper right lobe; (2) middle lobe; (3) lower right lobe; (4) upper left lobe; (5) lower left lobe; (6) aorta; (7) superior vena cava (vein); (8) inferior vena cava (vein); (9) main pulmonary artery; and (10) right lung veins.
When the Lungs Need Help
Sometimes the lungs can get very sick and stop working properly, preventing enough oxygen from getting to the body. When this happens and no medicine or treatment can help, doctors might decide to replace the sick lungs with new, healthy ones. This is called a lung transplant. A lung transplant is a surgical procedure that gives people with very serious lung problems a chance to live longer and do things like play, go to school, and have fun.
Kids sometimes need lung transplants too, although it does not happen often. Out of the 4,000 lung transplants done each year, only about 100 are for kids aged 0–16 [1, 2]. The two most common reasons why children need new lungs are cystic fibrosis (CF) and some heart diseases, both of which are present at birth. CF is a disease that makes the mucus inside the lungs very thick and sticky. This mucus can block the airways, making it very hard to breathe and causing frequent lung infections. Over time, the lungs can become damaged. Congenital heart diseases can cause very high pressure in the blood vessels of the lungs. When this happens for a long time, the lungs can slowly stop working properly.
Kids with very sick lungs might need special devices to help them breathe, but they cannot run, play, or go to school if their illness is too severe. Before a lung transplant, doctors do many tests to make sure the child is strong enough for surgery and will be able to take care of the new lungs. Doctors also measure things like blood type, height, and weight, and they place the child on a waiting list. While waiting, doctors and nurses follow the child very closely to keep them as healthy as possible before surgery (Figure 2).
- Figure 2 - (A) A child with end-stage lung disease waiting for lung transplantation.
- The lungs of this child do not take enough oxygen for the organs and tissues. (B) The same child after lung transplantation, with functional lungs. Now he has enough energy and oxygen for his normal life.
Donors, the Real Heros
Sometimes when people die, their lungs can still be healthy and could help someone else who needs them. Donors are people who decide to give their organs to others as a very kind and generous gift.
There are two types of donors: brain-dead donors and donors after cardiac death [3, 4]. Brain-dead donors are people whose brains have stopped working because of a serious injury, but whose organs can still work for a short time with the help of machines. Donors after cardiac death are very sick people who can only stay alive with medicines and machines. When these machines are stopped, the heart also stops working.
Organ donation is always a choice. Either the person decided to be a donor during their life, or their family makes this decision after talking with the doctors. This choice can help save other people’s lives. Doctors are very careful to make sure that organ donation is done with respect, kindness, and safety for everyone involved. When a person or their family agrees to donate their lungs, doctors look for the best match. They compare things like blood type, body size, and how urgently a patient needs new lungs.
The Long Journey to Taking a New Breath
When doctors find the perfect match between a donor and a child who needs new lungs, the transplant team calls the child and their family to come to the hospital. The doctors then start the lung transplant surgery, in which they take out the sick lungs and replace them with the new, healthy ones.
There are three kinds of lung transplants. Sometimes replacing just one lung is enough—this is called a single-lung transplant. Other times, both lungs need to be replaced—this is called a double-lung transplant. If the new lungs are too big, doctors might take smaller parts (called lobes) from each lung—this is called a lobar transplant (Figure 3).
- Figure 3 - Anatomy of a transplant.
- The donor’s bronchi (white), pulmonary artery (blue) and left atria (red) are stitched in a lung transplantation. Important structures include: (1) donor’s right pulmonary vein; (2) donor’s right pulmonary artery; (3) donor’s right main bronchus; (4) recipient’s left atria; (5) recipient’s right pulmonary artery; (6) main pulmonary artery. (A) In a double lung transplant, both lungs are transplanted. (B) In a single lung transplantation, only one lung is transplanted. (C) If the donor lungs are too big, just a lobe can be transplanted, which is called a lobar transplant.
Lung transplantation takes about 6–8 h. During the operation, doctors carefully remove the sick lungs and connect the new ones to the child’s bronchi (air tubes), blood vessels, and a small part of the heart, using tiny stitches. While one lung is being replaced, the other lung keeps the child breathing. If both lungs are being replaced, the doctors do this process twice. When the surgery is done, the new lungs start working, and the child is moved to a special area in the hospital called intensive care.
In intensive care, doctors and nurses watch over the child very closely to make sure everything is going well. A physiotherapist helps the child with breathing exercises and gentle movements to speed up recovery. Once the child can breathe on their own, they move to a regular hospital room and, after more recovery, finally go home. With their new lungs, kids can breathe easily, run, play, and go to school just like other kids!
A New Life, a New Chance
After a lung transplant, life changes a little bit. The child will need to take medicines and visit the doctor regularly for the rest of their life.
One very important type of medicine is called immunosuppressants, which help protect the new lungs. Because the lungs come from another person, the body may think they do not belong and may try to attack them. Immunosuppressants calm the body’s defenses and help the lungs stay healthy. Because immunosuppressants make the immune system weaker, the child also needs other medicines, such as antibiotics, antifungals, and antivirals, to help prevent infections [5].
In some rare cases, if the new lungs become very sick over many years, a person may need another lung transplant. Doctors follow transplant patients closely to detect problems early and treat them as soon as possible. Even though they need lifelong care, most children who receive a lung transplant can go back to school, play sports, travel, and enjoy everyday life with their friends and family.
In summary, our lungs help us breathe and give our bodies oxygen to live and play. Sometimes lungs get very sick and cannot get better. A lung transplant gives children new, healthy lungs from a kind donor. Thanks to doctors, nurses, and donors, kids can breathe again, run, play, and enjoy life.
Glossary
Lung Transplant: ↑ An operation where very sick lungs are replaced with new, healthy lungs from a donor.
Cystic Fibrosis (CF): ↑ A disease some children are born with that makes thick, sticky mucus build up in the lungs and makes breathing very hard.
Congenital Heart Disease: ↑ A heart problem that a child is born with.
Donor: ↑ A person who gives their organs after they die to help save someone else’s life.
Intensive Care Unit (ICU): ↑ A special hospital area where doctors and nurses watch very sick patients very closely.
Immunosuppressants: ↑ Special medicines that calm the immune system so it does not attack the new lungs.
Conflict of Interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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References
[1] ↑ Chambers, D. C., Perch, M., Zuckermann, A., Cherikh, W. S., Harhay, M. O., Hayes Jr, D., et al. 2021. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: thirty-eighth adult lung transplantation report — 2021; focus on recipient characteristics. J. Heart Lung Transplant. 40:1060–72. doi: 10.1016/j.healun.2021.07.021
[2] ↑ Hayes, D., Cherikh, W. S., Chambers, D. C., Harhay, M. O., Khush, K. K., Lehman, R. R., et al. 2019. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: twenty-second pediatric lung and heart-lung transplantation report–2019; focus theme: donor and recipient size match. J. Heart Lung Transplant. 38:1015–27. doi: 10.1016/j.healun.2019.08.003
[3] ↑ Avlonitis, V. S., Fisher, A. J., Kirby, J. A., and Dark, J. H. 2003. Pulmonary transplantation: the role of brain death in donor lung injury. Transplantation. 75:1928–33. doi: 10.1097/01.TP.0000066351.87480.9E
[4] ↑ Erasmus, M. E., van Raemdonck, D., Akhtar, M. Z., Neyrinck, A., de Antonio, D. G., Varela, A., et al. 2016. DCD lung donation: donor criteria, procedural criteria, pulmonary graft function validation, and preservation. Transplant Int. 29:790–7. doi: 10.1111/tri.12738
[5] ↑ Perch, M., Hayes, D., Cherikh, W. S., Zuckermann, A., Harhay, M. O., Hsich, E., et al. 2022. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: thirty-ninth adult lung transplantation report–2022; focus on lung transplant recipients with chronic obstructive pulmonary disease. J. Heart Lung Transplant. 41:1335–47. doi: 10.1016/j.healun.2022.08.007