If it seems like a lung transplant might be an option for your child, we’ll ask you to come to the hospital for an informational visit. Your family will meet our transplant team, and you’ll be invited to ask questions and share any concerns you may have. We encourage you to bring family and close friends to this initial meeting.
If you and the transplant team agree that a lung transplant is a good idea, your child will be scheduled for an evaluation. This is an extensive array of tests that are usually conducted over the course of four to five days. While this may seem like a lot, these tests are necessary in order for us to:
- confirm that a transplant is the appropriate treatment
- determine how urgent the need for a transplant is
- make sure that the donor organ your child receives will be a good match
The evaluation is usually done as an outpatient, but it can be completed with your child staying in the hospital if your insurance approves.
Who will we meet with during the transplant evaluation?
A transplant is a complex procedure that touches different medical specialties – that’s why you and your child will meet Children’s Hospital Boston experts from a number of different areas, including:
Cardiology - The cardiologist will monitor your child’s heart function and assess how well it is likely to stand up to the transplant.
Anesthesia - The anesthesiologist will review your child's medical and/or surgical histories and identify any risk factors associated with anesthesia.
Infectious disease - Our infectious disease specialist will perform a physical exam and review your child's vaccination records. We will want to know if your child has any particular environmental exposures or has recently traveled to a foreign country.
Otolaryngology - This consultation is required for all patients with cystic fibrosis in order to have their sinuses evaluated. The specialist may recommend sinus surgery, which requires an overnight stay in the hospital.
Psychiatry - A psychiatrist or psychologist will meet with you and your child to discuss coping strategies, stress management and family life.
Social service - The transplant social worker will meet with you and your family to identify support systems and discuss your feelings about transplant. He or she can provide you with information about resources related to finances, relocation expenses and support groups.
Nutrition - Our nutritionist will evaluate your child's diet and nutritional requirements. Maintaining a healthy lifestyle and good nutrition before the transplant is very important.
Physical therapy - The physical therapist will discuss the importance of exercising before transplant in a way that is appropriate for your child. The goal of developing an exercise plan is to help increase endurance and strength. The physical therapist will ask your child to take part in a six-minute walk test.
- Dentist - Before a transplant can be considered, your child will meet with her own dentist or one here at the hospital. The goal is to treat any cavities, infections or tooth abscesses before transplant, since these conditions can be problematic once your child begins to take medicine to suppress his immune system.
What tests are used during the evaluation?
Your child’s specialists will order different tests to rule out infections, determine functionality of organs and make sure a donor match is compatible. These types of tests may include:
- blood tests to determine blood type (a donor and recipient must have compatible blood)
- electrocardiogram (ECG or EKG) to examine the electrical activity of your child's heart
- echocardiogram (ECHO) to evaluate the function of your child's heart
- cardiac catheterization to view your child’s heart and blood vessels
- MUGA heart imaging to see how the heart walls move and how much blood is expelled with each heartbeat
- pulmonary function tests (PFT) to measure lung volume and the rate of airflow in the lungs
- chest x-rays to evaluate your child’s lungs
- CT scan to examine the chest and sinuses
- ventilation and perfusion scan (V/Q Scan) to compare the function of the left and right lungs
- magnetic resonance imaging (MRI) to produce detailed images of your child’s lungs
- lung biopsy to learn more about the condition of your child’s lungs
Some tests will check for exposure to viruses, bacteria and infections including:
5. Other kinds of tests
- liver and kidney function tests
- abdominal ultrasound to look for masses, obstructions and structural abnormalities in your child’s abdomen
- bone densitometry to determine the density of your child's bones
- nocturnal oximetry to monitor oxygenation during sleep
After these consultations and tests, the transplant team will meet as a group to determine whether your child is a good candidate for a lung transplant. Our multidisciplinary approach to care ensures that your child’s case will be given thoughtful discussion of every treatment possibility.
If your child is a transplant candidate, we’ll make sure your family is fully educated about the risks and benefits, and your child will be placed on the United Network for Organ Sharing (UNOS) list.
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