Lung Transplant: Purpose, Types, Surgery, Risks and Recovery
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is a lung transplant?
A lung transplant is surgery that removes a diseased or damaged lung and replaces it with a healthy donated lung; one lung, both lungs or the heart and lungs may be replaced. It may be considered when serious lung disease does not respond to other treatment. Lifelong immunosuppressant medicines are then needed to prevent rejection, which increases infection risk. [1]
What the research says
Double-lung transplant gave better lung function than single-lung transplant in pulmonary fibrosis. A meta-analysis of 16 studies (17,872 people with idiopathic pulmonary fibrosis) found that single-lung recipients had lower FEV1% after transplant (mean difference −15.37 percentage points; 95% CI −22.28 to −8.47), while overall survival did not differ significantly between the two types (HR 1.08, 95% CI 0.91–1.29) (Li et al., PLoS One, 2020). [2]
Pooled survival data for fibrotic lung disease favored double-lung transplant. A systematic review of 17 studies (5,601 patients) reported 5-year survival of 57% after bilateral versus 50% after single-lung transplant, and 10-year survival of 35.3% versus 27.8%. The authors noted that high-quality head-to-head evidence is limited and that studies conflict on short-term outcomes. These results come from studies of fibrotic lung disease and may not apply to every condition (Wilson-Smith et al., Ann Cardiothorac Surg, 2020). [3]
Why might someone need a lung transplant?
A lung transplant may be considered when lung damage or disease prevents the body from getting enough oxygen and other treatments no longer provide enough benefit. Transplantation is a major treatment option for serious lung disease that does not respond to other treatments. [1]
A candidate may be considered when life expectancy is fewer than two years without a transplant, the person does not use tobacco products, can take immunosuppressants, can follow a medication schedule and regular follow-up plan, and can maintain a healthy lifestyle with appropriate eating and physical activity. [1]
These points describe general considerations, not a self-screening tool. A transplant program makes decisions after a detailed medical, physical, psychosocial and functional evaluation.
Which conditions may lead to a lung transplant evaluation?
Many conditions can affect how well the lungs work. The following are examples of conditions for which a transplant may be considered when other treatments are no longer effective.
Lung condition | Context |
Bronchiectasis | A chronic condition that may be considered for transplant evaluation. |
A condition that may severely affect lung function. | |
Alpha-1 antitrypsin deficiency | A genetic condition that may lead to transplant consideration. |
COVID-19 fibrosis | Fibrotic lung damage that may be considered. |
Cystic fibrosis-related lung disease | Advanced lung disease related to cystic fibrosis may be considered. |
Scarring and damage that can impair oxygenation may be relevant. | |
Coal worker's lung disease | A severe occupational lung condition. |
A condition affecting the pulmonary circulation and lung function. |
For many people, medicines and therapies can successfully treat these conditions. Transplant evaluation may be discussed when treatments no longer help enough.
What are the types of lung transplant?
Lung transplants come in three main types, and the transplant team helps decide which one fits each person. The choice depends on the disease, the condition of the other organs and the transplant team's assessment. [1]
Type | What it involves |
Single-lung transplant | Surgeons remove one lung and replace it with a donated lung. |
Double-lung transplant | Surgeons replace both lungs with donated lungs. |
Heart-lung transplant | Surgeons replace the heart and both lungs with a donated heart and lungs. |
How does the lung transplant evaluation process work?
A lung transplant evaluation is extensive. The care team reviews the person's health and biological family history, performs a physical examination and orders tests such as blood tests, imaging and pulmonary function tests. [1]
The team also reviews the person's medication list, weight and overall eating pattern. It asks about personal support during the transplant period and evaluates mental and emotional health. [1]
After testing and meetings with transplant surgeons, the case goes to a selection committee. If the committee approves the person, the person is placed on a national waiting list. [1]
Evaluation area | What may be reviewed |
Medical history | Health history and biological family history. |
Physical status | Physical examination and overall condition. |
Lung function | Pulmonary function tests and other relevant testing. |
Laboratory and imaging data | Blood tests and imaging tests. |
Medicines | Current medication list and treatment needs. |
Nutrition and weight | Weight and overall eating patterns. |
Support | Personal support team during the transplant period. |
Mental and emotional health | Questions about psychological and emotional readiness. |
How do donor matching and the lung transplant waiting list work?
Donor matching considers compatible blood type, lung size and immunology. Immunology refers to how closely the donor's genes align with the recipient's immune system so that the risk of rejection may be lower. [1]
The recipient must have the same blood type as the donor, and the lungs need to be about the same size. A person may wait months until a good match becomes available. The transplant team can explain what to expect about waiting time. [1]
There are not enough donor lungs for everyone who needs a transplant. Organ-donation awareness and registration are ways to help increase the number of available donor lungs. [1]
Matching factor | Why it matters |
Blood type | The recipient and donor must have the same blood type. |
Lung size | Donor lungs need to be about the same size as the recipient's lungs. |
Immunology | Closer genetic compatibility may make rejection less likely. |
Availability | Donor lungs are limited, so waiting may last months. |
What should you expect before lung transplant surgery?
The transplant team explains the evaluation results, selection process and possible waiting-list pathway. The person may need to organize practical support, understand medication and appointment responsibilities, and prepare for an extended recovery.
Because transplant recovery involves frequent monitoring and therapy, a dependable support system can help during the evaluation, hospitalization and early recovery period.
The exact instructions before surgery come from the transplant team. This article does not replace the team's instructions about food, medicines, transportation, illness, travel or other preparation questions.
What happens during lung-transplant surgery?
Lung transplant is major surgery. General anesthesia keeps the person asleep and prevents pain during the operation. [1]
Once the person is asleep, the team may shave and sanitize the surgical area, connect a mechanical ventilator, place a urinary catheter and connect the person to an ECMO machine. ECMO can temporarily bypass blood flow to the heart and lungs, pump blood through the body, remove carbon dioxide and replace it with oxygen. [1]
The surgeon makes an incision, removes the damaged lung or lungs and replaces them with donor lungs. The donor lung is connected to blood vessels and airways. Small silicone drainage tubes are placed to remove blood, fluid and air from the chest, and the incision is closed and bandaged. [1]
Surgical stage | Description |
Anesthesia | General anesthesia is used so the person is not awake and does not feel pain during surgery. |
Breathing and circulation support | A mechanical ventilator and, when needed, ECMO may support breathing and circulation. |
Organ removal | The diseased or damaged lung is removed. |
Donor-lung placement | A healthy donor lung is placed in the chest. |
Connections | The donor lung is connected to blood vessels and airways. |
Drainage and closure | Chest drainage tubes are placed; the incision is stitched closed and bandaged. |
How long does the operation take?
A single-lung transplant takes about four to six hours. A double-lung transplant takes about six to eight hours.
The total time for a person and family may be longer because of preparation, anesthesia, recovery-room care and the immediate postoperative period.
What happens immediately after surgery?
After surgery, the person is moved to an intensive care unit. The team waits for the person to wake up and monitors overall health. The mechanical ventilator continues to help with breathing while the person is in the ICU. [1]
When the care team believes it is safe, it removes the ventilator and urinary catheter and moves the person to a post-transplant unit. The team monitors how the body responds to immunosuppressants and adjusts the dosages as needed. [1]
Physical therapists and respiratory therapists help rebuild strength in the lungs and the rest of the body. Most people stay in the hospital for 12 to 14 days, but the length of stay can be shorter or longer. [1]
What are the benefits of a lung transplant?
A lung transplant may improve quality of life when advanced lung disease has made breathing and everyday activity difficult. Potential benefits include easier breathing, more energy for daily activities and exercise, and no longer needing supplemental oxygen. [1]
These potential benefits do not guarantee a particular result. The transplant team discusses the individual's condition, goals, risks and likely recovery.
Potential benefit | Description |
Breathing | Breathing may become easier. |
Energy | A person may have more energy for everyday activities and exercise. |
Supplemental oxygen | A person may no longer need supplemental oxygen. |
Quality of life | A transplant may increase overall quality of life. |
What is the survival rate and long-term outlook after a lung transplant?
A 2023 report listed lung-transplant survival rates of almost 90% after one year, over 70% after three years, almost 60% after five years and over 30% after 10 years. Some people live more than 20 years after a lung transplant. [1]
These figures describe a population-level report and cannot predict an individual's outcome. Survival and quality of life depend on many factors, including health status, transplant type, complications, rejection, infection, follow-up and response to treatment.
Many people return to a good quality of life within three to six months. This is a general reference point rather than a promise about any one person's recovery. [1]
What are the risks and complications of a lung transplant?
Lung transplant has the risks of major surgery, including anesthesia problems, bleeding, blood clots and scarring. [1]
Transplant rejection occurs when the immune system attacks the donor lung. Acute rejection is more common during the first 12 months after surgery. Chronic rejection, also called chronic lung allograft dysfunction (CLAD), usually develops after the first year and affects about half of recipients within five years.
Infection is another important risk. Immunosuppressants reduce the chance that the immune system will attack the donor lung, but they also make it harder for the immune system to fight infections. Immunosuppressants are needed for the rest of a person's life. [1]
Risk | What it means |
Anesthesia problems | A possible risk of major surgery. |
Bleeding | A possible surgical complication. |
Blood clots | A possible surgical complication. |
Scarring | A possible result of surgery. |
Acute rejection | Immune attack on the new lung, more common in the first 12 months. |
Chronic rejection | Gradual, long-term rejection that usually starts after the first year; about half of recipients have it within five years. |
Infection | Risk increases because immunosuppressants make it harder to fight infections. |
How do immunosuppressants prevent lung transplant rejection?
Immunosuppressants help prevent the immune system from attacking the donor lung. The transplant team monitors the body's response and adjusts doses as necessary. These medicines are needed for the rest of a person's life. [1]
Because medicines can interact with one another, talk with the transplant team before starting any new prescription medicine, over-the-counter medicine, vitamin or herbal supplement. These products may affect how well immunosuppressants work. [1]
Do not stop, change or add transplant medicines on your own. The treating team's instructions should guide medication decisions.
What is the recovery timeline after a lung transplant?
Recovery occurs in stages. The incision takes about two weeks to heal. In most cases, walking and physical or occupational therapy begin two to three days after surgery. Lifting must be limited while the chest incision heals; most programs advise not carrying more than about 10 pounds for the first two to three months.
Driving may be possible after about six to eight weeks. After 12 months, the risk of rejection decreases, and lung function should continue to improve every few months. Stable lung function is expected about one year after surgery. Time away from school or work may last about six months. [1]
Individual recovery varies. The transplant team's instructions take priority over general timelines.
Recovery stage | Reference point |
Incision healing | About two weeks. |
Walking and therapy | Often begins two to three days after surgery. |
Lifting | Limit lifting during recovery; most programs advise not carrying more than about 10 pounds for the first two to three months. |
Driving | May resume after about six to eight weeks. |
Rejection risk | Decreases after 12 months. |
Lung function | May continue improving every few months; stable function is expected about one year after surgery. |
School or work | Time away may last about six months. |
What follow-up care is needed after a lung transplant?
Follow-up is frequent after discharge. Initially, a person may need one or more appointments each week for laboratory tests, check-ups and therapy. Once stable, outpatient follow-up may occur about every three months. [1]
Call the healthcare provider immediately if you are not feeling well, notice discomfort or experience changes in breathing. These symptoms may require prompt assessment for complications such as infection or rejection. [1]
Ask before starting any new medicine, supplement or vitamin. Even products available without a prescription may affect immunosuppressants.
When should you contact the lung transplant team?
Contact the transplant team immediately if you feel unwell, develop new discomfort or notice a change in breathing. After transplant, a person should not wait for a routine appointment if symptoms are concerning or worsening.
A simple record of symptoms, temperature readings if the team requests them, medicines and questions can help organize follow-up conversations. This is a practical planning suggestion, not a substitute for the transplant team's instructions.
What questions should you ask the lung transplant team?
Question | Why it matters |
Which transplant type is being considered? | Options include single-lung, double-lung and heart-lung transplantation. |
What tests are part of my evaluation? | Evaluation may include blood, imaging and pulmonary function tests. |
How will my support system be assessed? | The team reviews personal support during the transplant period. |
What determines donor matching? | Blood type, lung size and immunology are considered. |
How long might I wait? | Waiting time can last months and varies with donor availability and matching. |
What will happen in the ICU? | Ventilator support, monitoring and transition to a post-transplant unit may be part of care. |
What therapy will I need? | Physical, occupational and respiratory therapists help rebuild strength. |
Which medicines and supplements should I avoid? | New medicines and supplements may affect immunosuppressants. |
Which changes in breathing require an immediate call? | Feeling unwell, discomfort or breathing changes should prompt immediate contact. |
Conclusion
A lung transplant replaces one or both diseased or damaged lungs with donor lungs. It may be considered when serious lung disease prevents adequate oxygenation and other treatments no longer help. The process includes detailed evaluation, donor matching, major surgery, rehabilitation, lifelong immunosuppressants and regular follow-up.
If a transplant has been discussed, ask the transplant team about the evaluation, donor matching, waiting-list expectations, surgery, recovery, medication interactions, rejection and infection monitoring. Call the transplant team immediately for feeling unwell, discomfort or changes in breathing.
Frequently Asked Questions
Is a lung transplant a cure?
A transplant replaces damaged or diseased lungs with donor lungs and may improve breathing and quality of life, but it does not eliminate the need for lifelong immunosuppressants or follow-up. Rejection and infection remain important risks.
How many types of lung transplant are there?
There are three main types: single-lung transplant, double-lung transplant and heart-lung transplant.
How long is the surgery?
A single-lung transplant takes about four to six hours. A double-lung transplant takes about six to eight hours.
How long is the hospital stay?
Most people stay in the hospital for 12 to 14 days after a lung transplant, but an individual stay may be shorter or longer.
How long might I wait for donor lungs?
A person may wait months until a compatible match becomes available. Matching considers blood type, lung size and immunology.
What is immunology matching?
Immunology refers to how close the donor's genes are to the recipient's so that the immune system may be less likely to reject the donor lung.
Will I need a ventilator after surgery?
The mechanical ventilator continues to help with breathing in the ICU after surgery. The care team removes it when it is safe.
Will I need immunosuppressants forever?
Yes. Immunosuppressants are needed for the rest of a person's life after lung transplantation.
Can immunosuppressants cause infection?
Immunosuppressants help reduce rejection but make it harder for the immune system to fight infections, increasing infection risk.
When can I drive after a transplant?
About six to eight weeks is a general reference point for returning to driving. Follow the transplant team's instructions.
When can I return to work or school?
A person may be out of school or work for about six months. Recovery varies and the transplant team should guide the decision.
When is lung function stable?
Lung function may continue to improve every few months and should reach a stable level about one year after surgery.
What should I do before taking a new medicine?
Talk with the transplant team before taking any new prescription or over-the-counter medicine, vitamin or herbal supplement because it may affect immunosuppressants.
When should I call the transplant team?
Call immediately if you are not feeling well, notice discomfort or experience changes in breathing.
Related Reading
Pulmonary Fibrosis: Symptoms, Causes, Diagnosis, and Treatment Explained explains lung scarring, a common reason people need a transplant.
What Is Chronic Obstructive Pulmonary Disease (COPD)? Symptoms, Causes, Stages, and Treatment covers COPD symptoms, causes and treatments, including advanced options.
Immunosuppressants: A Guide to Managing Your Immune System explains anti-rejection medicines taken for life after a transplant.
Organ Donation and Transplantation: How It Works, Who Can Donate, and What Recovery Looks Like describes how organ donation works and how recipients are matched.
References
Cleveland Clinic. Lung Transplant: Purpose, Surgery, Risks & Recovery. Cleveland Clinic. Last updated April 29, 2026. https://my.clevelandclinic.org/health/treatments/23044-lung-transplant
Li D, Liu Y, Wang B. Single versus bilateral lung transplantation in idiopathic pulmonary fibrosis: A systematic review and meta-analysis. PLoS One. 2020;15(5):e0233732. PMID 32437437. https://doi.org/10.1371/journal.pone.0233732
Wilson-Smith AR, Kim YS, Evans GE, et al. Single versus double lung transplantation for fibrotic disease-systematic review. Ann Cardiothorac Surg. 2020;9(1):10-19. PMID 32175235. https://doi.org/10.21037/acs.2019.12.04
Disclaimer
This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional with any questions about a medical condition or treatment.
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