Chronic Obstructive Lung Disease - Surgical Procedures

Surgical Procedures

Surgery -- as a last resort -- may help some patients with COPD. Coverage for such procedures varies among insurance carriers. A major drawback is that patients must be in good enough health to undergo major surgery. By the time COPD is advanced, however, this is usually not the case. As a result, surgery cannot help most COPD patients.

The three available surgical options that are appropriate for some patients with COPD are lung transplantation, lung-volume reduction surgery, and bullectomy.

Lung Transplantation

Three-year survival rates after lung transplantation are about 60% for patients with emphysema or alpha-1 antitrypsin deficiency. Patients may have a transplant of one lung, both lungs, or the lungs plus the heart. The increasingly long waiting time for donor organs and the extraordinary expense are both obstacles to this procedure.

---

---

Candidates. The best candidates are under age 65 and have severe heart and lung disease, with a life expectancy of less than 18 months. However, lung transplantation is becoming more out of favor for patients with end-stage COPD because it is unclear whether it provides a "useful" quality of life.

Waiting Time. Up to one-third of patients awaiting lung transplantation die before a suitable donor is available. There were 1,661 lung transplant operations performed in the United States in 2009, according to the Organ Procurement and Transplantation Network. As of this writing, 1,881 people were waiting for a new lung.

The United Network for Organ Sharing (UNOS) assigns lungs for transplants based on an allocation score, rather than time spent on the waiting list. The allocation score takes into account the length of time a patient is likely to survive before and after a transplant. This policy applies to transplant candidates who are age 12 or older.

Complications. Transplant patients must take drugs that suppress the immune system to prevent the body from rejecting the transplanted organ. Nevertheless, rejection is the primary cause of complications and death. The mortality rate from the procedure itself is about 10%.