Patient Information

The Transplant Operation

Transplant Operation

What happens when there is a Donor Offer?
The Transplant Co-ordinator you will need to get to the hospital safely and in the shortest possible time. The Transplant Co-ordinator will arrange an Ambulance to collect you.

Important things to remember at this time:

  • You shall be fasting from the time of the call.
  • Bring your current medication and a list of the doses you take.
  • Bring your bag containing essential items e.g. night clothes, slippers, and the Mater transplant patient booklet.
  • Once you go on the Transplant Waiting List, have your bag packed and ready in case you get the call to come in.
    The hospital will not be responsible for any loss or damage to personal items, therefore you are advised not to bring any valuables with you.

Plan for the scenario of the Transplant not proceeding, e.g. someone to take you home and if you are on oxygen, that you would have enough portable oxygen to get you home.

When the Surgeon knows that the Transplant is going ahead for you, the transplant team need to proceed without delay. For this reason, you need to be as prepared as possible for surgery. A full pre-operative surgical workup will be carried out on you when you arrive at the Mater. Before we know if the Transplant is going ahead, a doctor will discuss the operation with you and then ask you to sign your consent form for the transplant.

You may also have to see an Anaesthetist prior to knowing if the transplant is proceeding. You will be started on immunosuppression (anti-rejection) medication before going to the operating theatre if the transplant is proceeding.

There may be other patients also brought to the Mater at the same time as potential recipients for the same donor offer.

Sometimes we have to cancel a transplant. There are many reasons for this and they include:

  • When the organs, are unsuitable.
  • Your cross match blood test show that you are antibody incompatible with the donor.
  • The organ may be found to be more suitable for another recipient.
  • If the surgeon feels that clinically you are not well enough to undergo transplantation at this time, for example high temperature or very abnormal blood results.

Although extremely distressing and disappointing, we will have to cancel the transplant if any of the above occurs. You and your family should prepare yourselves for this happening.

Although very rare, you may even have been given an anaesthetic by this time. We only want to give you lung/s which have a high chance of functioning well for you.

What are the survival figures after lung transplantation?
The Transplant Team will inform you of the centre’s survival figures. Your individual risks will be discussed with you in detail. The risk for an individual patient may be more or less than the average depending on their medical condition.

The commonest causes of death during the first year after transplant surgery are:

  1. Poor function of the transplanted lung.
  2. Acute rejection of the lung.
  3. Infection.
  4. Kidney Failure

In the long term, rejection and infection can still occur and there are additional risks caused by:

  1. Chronic rejection of the new organ.
  2. Kidney disease/impairment- a significant number of patients end up requiring dialysis longer term and some require kidney transplants in time
  3. Malignancy e.g. Skin cancer; post-transplant lymphoproliferative disorder (lymphoma).
In addition to the medical team, who will look after me following the transplant?
Our experience of transplant is that having a strong network or carers and support is an essential part of transplant and will enable you to return to independent living as soon as possible. However we also know that in the first few months following transplant, every transplant patient will need practical and emotional support with many aspects of their day-to-day living, particularly in the first few weeks following transplant.

As part of the medical social workers assessment, you will be asked to identify your primary carers or ‘care team’ – that is, family, friends or people who will support you while on the active transplant list and in particular in the post-transplant phase. It is important to speak with family and friends regarding who can realistically provide care to you on an ongoing basis.

This is a big commitment from your carers and the transplant team acknowledge the importance of their role in good transplant outcomes.
Some of the supports needed from your primary carers include, but are not limited to:

  • Supporting you emotionally and practically if you are called-in for transplant, and assisting you return home if the transplant does not go ahead.
  • Providing emotional support on an on-going basis.
  • Being available for education from different members of the team in the hospital before you come home following your transplant.
  • Ensuring your home is cleaned thoroughly prior to your return home, providing assistance with cooking, collecting medications and day-to-day tasks.
  • Transporting you to and from pre- and post-transplant clinic appointments in the Mater Misericordiae Hospital.

Post-transplant clinics are initially weekly until the post-transplant team indicate otherwise. In the initial weeks post-transplant, you will be unable to use public transport, so you will need to ensure someone can drive you to your appointment on-time and bring you home again – your post-transplant nurse will indicate when you can start using public transport again.

Your carers must be available to you for emergency and unscheduled appointments also- both for bringing you into the hospital and out from the hospital.

The team is aware of the significant impact and stresses that caring for someone pre- or post-transplant can place on family or carers. It is very important that carers also take care of themselves and their physical and mental health. There are various support groups that may be of benefit to both the patient and their carers – details of these groups are in this booklet. One group that provides advice and support to carers is The Carers Association (freephone 1800240724 or www.carersireland.com)

Please speak with the MSW or a member of the transplant team if you have any further questions about any of the above. During the transplant assessment process, the MSW will note who you identify as your main carers and is happy to meet with them if they have any further questions.

What is involved in the Transplant operation itself?
The transplant operation is complex and a large team of skilled professionals will be looking after you in theatre. There are many different roles including several different surgeons, anaesthetists, different nurses, doctors and perfusionists (perfusionists manage the heart/lung bypass machine)

You may be in theatre for up to ten hours or even longer depending on the type of surgery and your underlying condition.

The coordinators will keep your next of kin informed during the surgery unless you ask them not to. Usually a member of the surgical team will speak to your family after the surgery.

Where will I go immediately after the transplant operation?
Immediately after your surgery, you will be taken to the intensive care unit (ICU) to recover, where a team of specially trained staff will take care of you. Their goal is to help you recover as quickly and safely as possible. Among all the staff caring for you, there will be one nurse who is assigned just for you. The ICU is a very busy environment and you can expect bright lights and a great deal of activity during the day. For your safety, CCTV is operational in all patient rooms; live images are relayed to the nurses’ station but are not recorded. Many of the sounds you will hear will be from monitors and equipment but do not be frightened as you are in expert hands.

To help you breathe, an endo-tracheal tube (breathing tube) will be inserted while you are asleep in theatre. This tube will be connected to a ventilator to assist with your breathing in the immediate post-operative period. As you will not be able to talk or swallow while this tube is in place, your nurse will anticipate your needs and ask you questions that require only a ‘yes’ or ‘no’. When you are fully awake, the breathing tube will be removed, and you’ll be able to talk.

Nutrition: You will not be able to eat or drink while on the breathing machine. There will be another tube through your nose, which empties the acid from your stomach until you are able to eat and drink again. This tube is called a nasogastric tube. If for some reason it is a long time before you can begin eating and drinking again, you can be fed through your nasogastric tube. Usually it will be removed a few days after the surgery once you are allowed to eat and drink again.

Monitoring: You will also be attached to a heart and blood pressure monitor. There will be IV lines in the veins of your arms and neck that will give you fluids and medication. There will be tubes in your chest, draining fluid that may have collected there. These tubes will restrict your movement but will be removed within a few days of surgery. You will have a urinary catheter in place that will drain urine from your bladder continuously. You will have an incision which may be a sternotomy, a clam shell or thorocotomy incision and will be covered with a dressing. The stitches are not removed as they dissolve over time.

Pain relief: You may be concerned about the pain you will experience, however patients have reported that it is not as severe as they anticipated. To control your pain, you will be given pain relief, which will be administered intravenously, orally or via an epidural. An epidural involves a small line inserted into your back by an anaesthetist which will block pain to a specified area around your surgical incision.

It is worth knowing that most patients who have spent time in ICU do not remember much about this initial period. This is due to the medication given, to keep them asleep and free from pain. However, some patients have reported hallucinations, which are not unusual and should reduce over time. You may want to talk to someone if this happens to you.

A typical stay in the ICU is 3-5 days and then you will continue your post-operative care in a high-dependency area, usually Cardio-thoracic High-Dependency Unit (CTHDU). You can expect to be in hospital for a total of 10-14 days, however this may vary depending on your condition.

Physiotherapy: The physiotherapist will see you in ICU This is a vital part of your care and this will start from day one in the ICU. This will involve –breathing exercise to help clear any sputum from your lungs and getting you out of bed a soon as possible. As you progress you will be encouraged to become more active and mobile.

Visitors: In ICU, visitors are limited to immediate next of kin, a maximum of two visitors at a time. The visiting hours are: 2.00-4.00pm and 6.30-8.00pm. The staff will ask your visitors to wash their hands on entering and leaving the unit. It is helpful to have one key person who will inform the rest of your family/friends about your progress to avoid you and the nursing staff being disturbed by frequent telephone calls.

Where do I go after the Intensive Care Unit?
When you no longer require Intensive Care, the majority of patients move to the CTHDU, although some patients may go to other wards notably to the Heart and Lung Transplant Ward or St Cecilia’s ward.

Whilst most of the monitoring equipment will have been removed, you may still have a cardiac monitor, a urinary catheter, chest drains and intravenous infusions/feeding tubes that were mentioned earlier. Over the following days these will be gradually removed as your condition improves. You will be encouraged to eat, drink, move about, and take care of your own needs as you progress.

Unlike Intensive Care, the nurse who is looking after you will have other patients to care for also. You may feel a little unsettled to begin with, but remember that you would not have been moved to the ward unless your condition was progressing as expected

Why is it important to eat well post transplant?
Eating well is a vital part of your rehabilitation. This will help to promote wound healing; muscle strength and speed of recovery. The dietician will meet you and your family during your stay in CTHDU to provide support and guidance and answer any question you may have
Can my family bring in food for me?
We advise not to bring in hot food prepared outside the hospital; this is in line with hospital policy. Re-heated food may cause stomach upset and interfere with absorption of your transplant medication.
Who will help me rehabilitate after my transplant?
The physiotherapist will help you to become more active and you will become more independent as you recover. Please bring loose fitting day cloths (Track Pants/Tee-shirts) and footwear i.e. sandals with Velcro straps for walking. You will be expected to be out of bed most of the the day.

The physiotherapist will help you plan your own exercise programme, which will help you reach your own personal goals. You will need to wear a disposable mask over your mouth and nose when outside the ward. Nursing staff will use it.

As you progress you will be encouraged to become more active and mobile. You will be aiming to be able to walk the length of the corridor and climb a flight of steps before discharge.

Can I have a family member present during the day to help with all this new information?
  • You are not allowed visitors the first week after the transplant. It is important that you understand this and discuss it with your family before you have your operation.
  • We encourage your family to visit only at the set visiting times. This allows members of the nursing and multidisciplinary team to prepare you for discharge.
  • During visiting hours you may have two family members at any one time. Relatives complaining of flu like or GI (vomiting/diarrhoea) symptoms should not attend the unit. All visitors must clean their hands using alcohol gel on entering and leaving the room. Relatives do not need to wear disposable aprons or masks.
  • We do not allow patients who have already had transplant to visit you in hospital.
  • We make every effort to prepare you to be self-caring and independent by the time you are discharged home. If your nursing team feel that you require more assistance we will involve a person that you choose in your care as you prepare for discharge.
  • We encourage you and your family to tell us about any literacy issue as soon as possible to avoid unnecessary stress. This will allow us to provide the support that you need to learn about new medication and lifestyle following transplant.
  • As mentioned before, you will need to take immunosuppressive therapy and other drugs for life. This helps to prevent the risk of rejection and reduces the risk of complications.
Why is it important to meet the Lung Transplant Nurse Specialist?
During this recovery period, you will be visited by the Lung Clinical Nurse Specialist. Information will be given with regards to potential complications, follow-up care, transplant clinics and life-style changes following transplantation. It will be beneficial if a family member or care giver is available to discuss discharge planning.

HEART EXAMINATIONS

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History of Lung Transplants


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