Talk:Heart–lung transplant

Statistics edit

I removed unsourced survival statistics and replaced them with a sourced survival statistic. I was going to just flag it as needing citation, but it was a very extreme claim about survival rates, and had a citation on it for a page about survival rates for kidney transplants, but no supporting evidence for the claims about heart-lung transplant survival rates.

87.80.97.137 (talk) 09:24, 22 July 2009 (UTC)

Page move: en dash

I moved it from the hyphen to match what I found in the article text itself. Before doing so, I consulted User:Noetica by email. This is the relevant excerpt from his response:

“ Not as clear as most cases; but on reflection I favour en dash.

It is not like "gall-bladder operation" or "gall bladder operation" ("lung" is not modified by "heart"; and there can really be no question of a join like "gallbladder", seen in American English). The components are reversible, against common usage but not against semantics or logic ("lung–heart operation"); yet it is not like "parent-teacher" (there are two distinct items named: a heart and at least one lung). It is more like "Finland–Sweden cooperation", but without the implication of mutuality.

One bizarre misconstrual is possible: that a heart and a lung change places! But that shouldn't count against en dash.

”

Tony (talk) 07:37, 13 October 2011 (UTC)

Reason?

I'm wondering why this is a separate procedure than a heart transplant and a lung transplant. Heart transplantation also mentions the "domino transplantation":

In 1988, the first "domino" heart transplant was performed, in which a patient in need of a lung transplant with a healthy heart will receive a heart-lung transplant, and their original heart will be transplanted into someone else.

This seems to suggest that transplanting both organs at the same time is somehow more successful…? --Rohieb (talk) 13:30, 12 March 2021 (UTC)

There are a few questions here, as far as I can tell:

1. Why is heart–lung transplantation considered a single procedure?
2. Why is heart–lung transplantation performed as a single procedure?
3. Is "domino" heart–lung transplantation — wherein a patient who is "in need of a lung transplant" but possesses "a healthy heart" nevertheless undergoes heart–lung transplantation, and their heart is "transplanted into someone else" — associated with better patient outcomes than lung transplantation alone?

I appreciate that this comment is years old, but they're good questions, and the article doesn't do enough to answer them. I have no medical expertise, but I think I can at least fill in a few of the missing links.

1. In its primary indication, heart–lung transplantation is a treatment for patients who simply require both heart and lung transplants, typically for related reasons.
2. As described in the history section of the lung transplantation article, lung transplantation was largely unsuccessful before the development of two prerequisite medical technologies: ciclosporin, an immunosuppressant drug used to prevent transplant rejection; and the "heart–lung machine", which takes over the functions of the patient's heart and lungs during the surgical procedure. According to this paywalled source, there was a historical period during which heart–lung transplantation was indeed preferred to lung transplantation alone, in part because then-current methods of lung transplantation required the induction of cardiac arrest in the patient.
3. Eventually, the development of "bilateral sequential single lung transplantation", which substantially improved lung transplant outcomes, lead to a reduction in the number of heart–lung transplantations performed. Major surgical centres adopted this new method, which does not require cardiac arrest, accompanied where necessary by surgical interventions to support or repair cardiac function. The prognosis section of the lung transplantation article provides some comparative post-transplant survival data. Lung transplantation alone is more successful, but only slightly (although recent data, I think, would show a bigger difference...?). The "domino" transplantation protocol is described at length in the source I referred to earlier. During the period when heart–lung transplantation was the preferred or only treatment for certain conditions, surgeons realised that the recipients of these transplants presented a unique resource: their hearts, which were not necessarily damaged irreversibly. This was a big deal: it dramatically expanded the donor pool — and the donated hearts came from living recipients. Outside of organ-harvesting schemes universally regarded as criminally unethical, this is rare, and it apparently has some clinical significance. As the source puts it: “Domino” cardiac procedure is an effective option to increase the donor pool when heart-lung transplantation [...] is the only treatment for patients with terminal cardiopneumopathy.

Foxmilder (talk) 10:02, 7 January 2024 (UTC)