My Surgery: Lung Transplant Surgery Guide

Once a lung(s) becomes available, you will receive a call from a Transplant Coordinator. The call for a transplant may come at any time of the day or night.

The transplant coordinator on-call will call three numbers that are ranked. They could include:

1. Home phone number
2. Alternate phone numbers, such as a cell phone number number
3. A relative's number

The coordinator will ask you a few questions:

• How are you feeling?
• Do you have any symptoms of a cold or fever?
• Are you taking any antibiotics?
• Have you had any new medications prescribed?

If there are no concerns about your current health, they will ask you to come to the hospital as soon as possible. We expect you to arrive at the hospital within 3 hours after you are called in for a lung transplant. The coordinator will tell you where to go once you arrive at the hospital.

• Do not drink from this point on.
• You can take your medication, with a small amount of water. It is OK to take your puffers.
• Diabetics should not take their insulin or diabetic pills before they come in because your blood sugar may drop without anything to eat or drink. Your blood sugar will be checked when you get to the hospital.
• If you refuse to come in when called for transplant, you will immediately be placed on hold and we must contact your transplant coordinator to discuss your situation.
• Time is critical when your lung(s) becomes available. The coordinator will call all your contact numbers repeatedly for 1 hour. Messages will be left where answering machines are available. If they cannot reach you, another recipient must be chosen.
• If you are unable to reach the person who calls you, are delayed due to weather or traffic contact the Transplant Ward at 416 340 5163; ask to speak to the Charge Nurse.
• Before you leave home, please remove all your jewellery. Please also remove all body piercings (ears, nose, tongue and belly button) before you leave home.
• You are responsible for arranging your own transportation to the hospital.
• If you decline to come in when called for transplant, you will immediately be placed on hold and must contact your Transplant Coordinator to discuss your situation.

In some cases, you may be called in as a back-up. This happens when there is a chance that the primary person may not receive the lung(s). Whenever possible, we will try to have you stay at home during this waiting period for final tests. If tests show that the primary person on the list is not a good match, then you, as the back-up, will be given the lung(s).

There is a chance that your lung transplant could be cancelled. Your surgery can be cancelled for a few reasons:

• We may have found the donor lungs unsuitable for transplant at the last minute.
• One of your tests may have an unusual result and the operation cannot safely proceed.
• In some cases, there may be an issue in matching an organ to a recipient.

If your transplant is cancelled, you and your family may feel shock, disappointment, and sadness. All of these feelings are normal. You should call your Transplant Coordinator to talk about any concerns you have about a cancellation. You are still on the transplant wait list and now know what to expect the next time you are called in.

• If you arrive between 7:00 am and 11:00 pm: Go to Admitting and you will be given further directions to the Transplant Inpatient Unit or another unit; there you will be examined by the lung transplant team.
  Admission Clinic
  Toronto General Hospital
  Eaton Building – Ground Floor, Room 400
• If you arrive between 11:00 pm and 7:00 am: Go to the Emergency Room, talk to a triage Nurse, and get directions as to where to be admitted.
  Toronto General Hospital
  190 Elizabeth Street (Enter at corner of Elizabeth and Gerrard Streets)
  R. Fraser Elliott Building - Ground Floor
  Phone: 416 340 3946
  TGH Maps & Directions

• Nurses and doctors will examine and prepare you for the operation.
• Blood tests, an ECG, and a chest x-ray will be done.
• An intravenous line (IV) will be inserted into your arm.
• Doctors will see you to discuss the surgery and answer any questions you may have.

On this page, you can read all about what to expect during your hospital stay. Or, just click on one of the links below, to get the answer you want right now.

• Right after your operation
• How will you feel after your operation
• The next steps
• Taking care of yourself after operation
• Learning about your medication
• How long you will stay in the hospital

You will wake up in the Medical Surgical Intensive Care Unit (MSICU). The average stay there is 2 to 3 days, but varies with each recipient. Our first priority is making sure your new lung are working well. Your transplant team will watch you closely for signs and symptoms of any complications (rejection or infection) and will make changes to your care as needed.

• Initially, you will have an endotracheal (ET) tube through your mouth into your windpipe to help with your breathing. This is connected to a breathing machine called a ventilator. The ventilator breathes for you during your surgery and during the early period after surgery. You will have drainage tubes in your chest called chest tubes for up to 2 weeks. These tubes drain fluid and air from the spaces around the lungs and the heart.
• You will have a catheter in your bladder to drain your urine and you will receive IV fluids for fluids and medication.
• A Nasogastric Tube will be inserted in your stomach until you are able to take in enough food. Your diet will gradually change from liquids to solid foods, as tolerated.
• Blood samples will be taken frequently to check the status of the new lung, as well as other body functions.
• You will remain in the ICU until your lung function is stable and you are able to breath on your own.
• We also ask that you designate only ONE family member to act as family spokesperson, calling the ICU for periodic updates.

• Once you have recovered from the anesthetic, you will feel some pain in your chest at the site of your incision. You may also feel stiffness and aches in other areas.
• You will have to take pain medicine, as needed. It will help you start moving around, sitting, and walking sooner.
• Our pain management team will work with you to make sure your pain is well managed.

1. Step-down Unit: The Acute Care Unit (ACU).
   • After the M/S-ICU you will be transferred to the Transplant Step-down Unit, which is also referred to as the Acute Care Unit (ACU).
   • The ACU is on 10AWest, across the hall from the M/S-ICU. You will be admitted here for several days as your condition improves. The setup is similar to the ICU with private rooms however each nurse in Step-down cares for more than one patient.
2. After the ACU – Care on the Transplant Unit
   • You will complete your recovery on the Transplant Unit on 7 West A – PMB. The staff will help you recover, gain strength, and learn how to manage with your organ transplant. The nurses on the Transplant Unit are specially trained to care for transplant recipients.

After the operation, you will immediately begin treatment with medication designed to prevent your immune system from rejecting your new lung. These types of medications are known as immunosuppressants. You will now take these medications for life.

Moving your body is an important part of your recovery. Movement will help protect your skin from pressure sores and keep your lungs clear. It will be painful because of the incision site and chest tubes. The nursing staff will assist you to move and make you as comfortable as possible.

• Start some deep breathing and coughing exercises. This is most important. It will help improve your lung function and prevent developing pneumonia. We'll show you a breathing exercise called Incentive Spirometry.
• Wiggle your toes and move your feet. This helps the blood in your legs to circulate.
• You will be encouraged to sit up and walk as soon as you are able.
• Sitting up in a chair, performing self-care, and walking in the hallway are excellent ways to improve your strength and stamina.

Nurses, pharmacists, dietitians, physiotherapists, and other members of the transplant team will teach you how to take care of yourself once you are discharged from the hospital.

On the Transplant Inpatient Unit, you will learn about your new life with a lung transplant, including how and when to take your new transplant medicines and any side effects you may have. You will meet with one of our transplant pharmacists. The pharmacist will answer any questions you may have about your new medicines. You can also visit our patient toolbox to learn more about your transplant medicines and life after transplant.

If you have sudden shortness of breath or chest pain, dial 911 and go to your nearest emergency room.

• You cannot eat grapefruit or drink grapefruit juices after transplant. It interferes with your immunosuppressive medications.
• Eating a healthy diet, by following Canada's Food Guide, will help give you a balance of protein, fats, and carbohydrates and help you to maintain a healthy body weight. For more diet information see – Healthy eating after your lung transplant.

• You might get tired easily. Listen to your body and don't do more than you can handle.
• If you are looking for counseling or a support group – before or after your transplant - please talk to a lung transplant social worker or your lung transplant coordinator.
• Our transplant psychiatry team is here if you need help with the following:
  1. Anxiety and depression
  2. Stress management
  3. Support and coping
• The Transplant Psychiatry Program offers a Mindfulness-Based Stress Reduction (MBSR) program. For more information, please call: 416 340 4452 or fill out the Mindfulness-Based Stress Reduction (MBSR) program application form.

• Strength training is important after your operation. Your physiotherapist will give your guidelines on the intensity of this type of exercise.
• Walking is the best exercise. Try to increase the distance and speed you walk.
• In winter, many people walk in malls to avoid icy surfaces and cold conditions, or they use a treadmill, if they have one.
• Your incision needs time to heal. Bench pressing is especially straining on the chest. It should be avoided for the first 3 months.
• Don't lift heavy things for 3 months after your operation.
• Anything over 5 kilograms or 10 lbs. is too heavy. You can use small weights of 1 kg to increase arm strength but be careful not to strain your shoulder joints.
• Lifting larger amounts may result in stress or separation of your incision, which can affect your healing.

• Do not take pain relief medications known as NSAIDs (non-steroidal anti-inflammatory drugs). This includes ibuprofen (the active ingredient in Advil® and Motrin® products); naproxen, which is found in Aleve® and Naprosyn®; and also ASA or Aspirin®.
• If you are taking an 81mg 'baby' Aspirin® once daily to prevent heart attack and stroke, this is okay if it is on the advice of our team. If you need to take medication for pain or a headache, acetaminophen (Tylenol®) is usually a safe choice. Talk to your transplant team before taking any other pain medication.
• Please consult your transplant team for direction in managing any cold symptoms.
• You cannot have any type of live vaccine as it could be harmful to you. This includes measles, mumps, rubella, shingles vaccine and yellow fever vaccine.
• Many drugs can interact with your transplant medications. Before you take any new medications, including any over-the-counter products or medications prescribed by a non-transplant doctor, you are encouraged talk to your transplant team.
• If you would like to take a multi-vitamin or any herbal remedy (including herbal teas), please talk to your transplant team first. Herbal remedies are like drugs and may interfere with your medications so proper precautions need to be taken.

• Do not drive for 3 months after your transplant.
• Do not drive yourself to the hospital on days you are scheduled for a Bronchoscopy, otherwise the procedure will be cancelled.
• Do not drive if you feel tired, are having dizzy spells, headaches or visual disturbances.
• You cannot drive while you are taking narcotics for pain control.
• Always wear your seatbelt when you are driving or riding in a vehicle.
• If your incision is tender, put a towel under your seatbelt to protect your incision.

Easy Call lets our transplant recipients and their transplant coordinators communicate with each other. Before being discharged from the unit, you will receive the Easy Call phone number and your unique personal identification number (PIN). We will make sure you know how to use the system, and set up a password, before you leave.

If you are experiencing health issues or concerns please use Easy Call to leave a message for your transplant coordinator. Use Easy Call if you have any of these symptoms:

• Your temperature goes higher than 37.5 - 38ºC (100ºF), and/or you feel chills.
• There is significant redness, swelling or increased pain at your incision.
• Worsening of shortness of breath.
• Persistent cough.
• Change in colour of sputum (mucus).
• More sputum than usual.

Use Easy Call to speak with your transplant coordinator about post-operative questions.

Who Do I Call In An Emergency?

If you have an emergency, please go to the closest emergency room or call 911.

Can I Email My Coordinator?

Talk to your transplant coordinator about email options. A consent form is required.

Before you leave the hospital we will arrange your follow-up clinic appointments. A detailed plan will be given to you, based on your progress and your transplant team's recommendations.

When
For the first 2 months after your operation, we will see you once a week for blood tests. As you recover you will not need to come to the clinic as often.

Where
Lung Transplant Clinic
Toronto General Hospital
Peter Munk Building - 12^th floor
TGH Maps & Directions

What to Expect
You will need to have weekly blood tests. The results will be viewed by the transplant team, who will follow-up as necessary.

Regular clinic visits allow your transplant team to monitor your health and deal with any concerns or changes.

What to bring

• OHIP health card, or other form of government-issued ID
• Bring all medications and a list of your medications to each clinic visit
• Bring a list of questions
• Have your bloodwork, chest X-ray and pulmonary function tests done before the clinic, as instructed by your transplant coordinator.

* Do you live outside the GTA?

Patients who live outside the GTA are required to stay local for the first 3 months after their transplant.

Tips for clinic:

• Before each clinic visit, it is a good idea to check Easy Call to see if there has been a change in your scheduled appointment.
• When you arrive for every appointment, check in with the transplant reception area and inform the receptionist if your phone number, address, or other contact information has changed.
• Inform the receptionist if you have a new cough, fever or diarrhea.
• Attend all scheduled appointments. If you are unable to make your appointment, call the receptionist and reschedule at: 416 340 4800 Ext. 4113.
• Book your next clinic appointment before you leave.

If you are experiencing health issues or concerns please use Easy Call to leave a message for your transplant coordinator. Use Easy Call if you have any of these symptoms:

• Your temperature goes higher than 37.5 - 38ºC (100ºF), and/or you feel chills.
• There is significant redness, swelling or increased pain at your incision.
• Worsening of shortness of breath.
• Persistent cough.
• Change in colour of sputum (mucus).
• More sputum than usual.

Use Easy Call to speak with your transplant coordinator about post-operative questions.

If you have an emergency, please go to the closest emergency room or call 911.

Talk to your transplant coordinator about email options. A consent form is required.