Heart–lung transplant

How the operation is performed

The procedure begins with removal of the recipient's heart and lungs. A cardiopulmonary bypass machine pumps and oxygenates the blood during the transfer, allowing surgeons to implant the donor heart–lung block and reattach major blood vessels and airways. Key technical elements include proper alignment of the pulmonary arteries and veins, secure anastomoses of the aorta, and bronchial connections. Perioperative management and immunosuppressive therapy are critical to prevent rejection. Learn more about cardiac and pulmonary aspects at cardiac resources and pulmonary resources.

Indications and patient selection

Typical reasons to consider a heart–lung transplant include congenital heart defects with secondary lung disease, pulmonary vascular diseases that severely damage the heart, or combined end-stage disease of both organs. Candidates are evaluated for overall health, ability to tolerate major surgery, absence of uncontrolled infection or malignancy, and social support for the demanding recovery. Donor availability and matching are also essential; information about donor organs is available via donor organ guidance.

Outcomes, risks and alternatives

Outcomes depend on the patient’s condition before surgery, the quality of the donor organs, and postoperative care. Risks include surgical complications, infection, rejection, and long-term effects of lifelong immunosuppression. Because suitable donor heart–lung blocks are scarce, the operation is uncommon; organ shortage and allocation policy limit frequency. For context on donor supply limitations see organ donation issues.

Notable facts and distinctions

• Heart–lung transplant differs from sequential single-organ transplants in that a contiguous donor block is implanted, reducing some technical challenges but requiring donor lungs and heart from the same donor.
• Less invasive or alternative approaches—such as isolated lung transplant with mechanical circulatory support, or ventricular assist devices combined with lung therapies—may be considered when appropriate.
• Long-term follow-up includes surveillance for chronic rejection, routine bronchoscopy in some centers, cardiac imaging, and careful immunosuppression management.

Because the procedure is rare and resource-intensive, it is typically performed at specialized transplant centers with multidisciplinary teams experienced in managing complex cardiopulmonary failure.