A heart-lung transplant is the last resort for people suffering from dual heart and lung failure, where neither of these organs have a chance of recovering. There are various conditions that act as risk factors for dual-organ failure. They include Eisenmenger syndrome, certain congenital heart conditions, and certain disorders associated with hypertension in the lungs. The procedure can be a life-saver for such people. In this article, we will learn more.
There are many end-stage conditions that cause failure of both the heart and pair of lungs after some stage. Previously, people in this situation would undergo either a heart, or a single-lung or a double-lung transplant, to see if the situation improves. This is because it is much more complex to transplant both the heart and lungs, as against transplanting either organ alone. There is a complex web of nerves, musculature, lymphatic system and other tissues that envelop or enmesh both these organs. A dual-organ transplant will require cutting through all these tissues to remove the failed organs, and then stitching them all back in place after the transplant.
In some cases, transplanting only the heart (called isolated heart transplant) or only the lungs (isolated single-lung or dual-lung transplant) may result in a marked improvement in the person’s condition. The progress is then sustained by advanced medication and other therapies. However, there is a small fraction of people for whom there is no choice but to perform a transplant of heart and both lungs. This is called a dual-organ transplant, and indicated by the abbreviation HLTx.
The heart and lungs are harvested from cadaver donors. The set of organs, called a ‘heart-and-lungs-block’ is carefully stored, transported and the prospective recipient on the waiting list tested, before the transplantation. Persons on the dual-organ-failure waiting list will get priority over cadaver organs, compared to people on waiting lists for either heart alone, or lungs alone transplantation. At this juncture, we must understand some other aspects too.
Heart transplantations have been around since 1967 when they were performed for the first time. In the past, the success rate for heart transplants were low due to the risk of organ rejection from the person’s immune system. However, over years, there has been a marked improvement in the ability of immunosuppressant drugs to reduce the chances of rejection. Further, technology is coming to the aid of such people.
A mechanical, balloon pump implanted into the aorta along with a battery power source helps in pumping the blood. This acts as a bridge device that can temporarily take over the heart function for people who are slated for transplant in the short run.
In the last couple of decades, Ventricular Assist Devices (VADs) and Total Artificial Hearts (TAHs) have reduced the need for heart transplant. We have covered them in earlier articles, so will make a brief mention here. VADs are electromechanical devices that can take over the function of either or both ventricles of the heart and can work for several months to several years. TAHs are relatively new. In addition to their exorbitant cost, the risk of side-effects and complications are important considerations.
Compared to heart transplant, lung transplant is relatively easier and have been around since the 1980s. Doctors have successfully transplanted either, or both lungs, or portions of them (called lobes) into a recipient.
In all those people in whom both the heart and lungs are damaged, doing an isolated heart or isolated lung transplant will be of no use. For such people, a dual-organ transplant is inevitable and can help the person prolong his/her life while improving the quality of life. There are risks from this procedure, but plenty of benefits too. They are the last resort when all other therapies have failed.
The conditions which necessitate dual organ transplant are:
So how are the cadaver donors for an isolated heart, isolated lung, or dual-organ transplant chosen? What are the criteria for the donors that are required for transplant? They include:
The immune system is responsible for recognizing foreign bodies in the human system and fight them as if they were intruders. In addition to bacteria, viruses, fungi and parasites, the immune system also treats transplanted organs (called ‘graft’) as a foreign body and relentlessly attacks the same. This is what causes organ rejection, or a failed organ transplant.
This is precisely why; graft recipients must take immunosuppressant drugs for the rest of their life. Organ rejection does not mean the graft is defective, or a repeat transplant has to be done. Rejection can happen within six months of transplant (early rejection) or after six months (late rejection).
The person slated to have a dual-organ transplant must go through the following diagnostic tests before the procedure:
After the above tests are conducted, the person is again evaluated, to decide if he/she needs a dual-organ transplant. In some cases, a single-lung transplant may be adequate, sometimes a dual-lung transplant is preferred and sometimes, a dual-organ transplant is recommended. At the time and day of surgery, depending on various factors, the cardiothoracic surgeon and a group of specialists will decide what kind of transplant will be done finally. Some of these factors include availability of cadaver organs, their quality, the conditions in which the donor passed away, and present health of the recipient.
In case, only one lung or only the lungs are adequate and the heart need not be transplanted, then the harvested heart is given to a person on the heart transplant waiting list. The same is true vice-versa, for the heart alone being transplanted and the lungs being spared. The goal of all these tests, evaluations and calculations, is to ensure the transplant is successful, recovery is quick and there is no risk of complications.
The techniques involved are highly techno-medical in nature and describing them will require the use of terminology that is beyond the comprehension of people outside the medical community. That is why, we will simplify and summarize the same here.
If you or a loved one is facing complex heart or lung conditions, expert care is crucial. Kauvery Hospital, with branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, offers advanced cardiac and pulmonary transplant, ensuring comprehensive treatment and support for every patient.
A heart-lung transplant (HLTx) is a complex surgical procedure where both the heart and lungs are transplanted together from a donor to a patient. It’s recommended for people whose heart and lungs are both severely damaged and cannot recover through medication or single-organ transplants.
This transplant is usually advised for patients with end-stage conditions like Eisenmenger syndrome, congenital heart defects, pulmonary hypertension, idiopathic pulmonary fibrosis, or severe coronary artery disease that has affected both the heart and lungs.
When only one organ—heart or lungs—is failing, a single-organ transplant may be enough. However, if both are severely damaged and cannot function properly, a dual-organ (heart-lung) transplant becomes necessary to restore healthy breathing and blood circulation.
Donors are carefully chosen based on strict medical criteria. They must be young (usually under 45 years), free from chest trauma or infections, and have compatible blood type and organ size with the recipient. Donors are also screened for diseases like HIV and hepatitis.
The biggest risk is organ rejection, where the immune system attacks the new organs. To prevent this, recipients must take lifelong immunosuppressant medications. Other possible risks include infection, bleeding, and complications from surgery.
Patients undergo detailed tests such as ECG, echocardiography, lung function tests, CT scans, cardiac catheterization, and blood typing. These ensure the patient is fit for surgery and helps doctors decide whether a single or dual transplant is required.
Surgeons remove the patient’s damaged heart and lungs and replace them with healthy donor organs. They then connect the major blood vessels, trachea, and airways carefully to restore normal breathing and blood flow.
After surgery, the patient’s lung and heart function are closely monitored through biopsies and spirometry. Regular follow-ups, blood tests, and medication adjustments are essential to prevent rejection and ensure proper recovery.
With proper medical care, lifestyle changes, and regular follow-up, many patients live for years with improved quality of life. Survival largely depends on overall health, age, and adherence to post-transplant medication.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet, Vadapalani & Radial Road), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and paediatric trauma care.
Chennai Alwarpet – 044 4000 6000 • Chennai Vadapalani – 044 4000 6000 • Chennai Radial Road – 044 40504050 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4077777 • Trichy – Tennur – 0431 4022555 • Maa Kauvery Trichy – 0431 4077777 • Kauvery Cancer Institute, Trichy – 0431 4077777 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 68011
