The United Network for Organ Sharing reports more than 1,400 lung transplants were performed in the U.S. last year. A transplant is needed for patients with irreversible lung damage, limiting the ability of the lungs to take in oxygen and release carbon dioxide.

Researchers say the most common reason for a lung transplant is chronic obstructive pulmonary disease (COPD). This condition is a combination of two diseases, chronic bronchitis and emphysema. The American Lung Association estimates 11.4 million American adults have COPD. It's the fourth leading cause of death in the U.S. Smoking is a major risk factor.

Another indication for lung transplant is cystic fibrosis (CF). Patients produce abnormally thick, sticky mucus, which can obstruct the airways in the lungs and cause problems with digestion and absorption of nutrients. About 30,000 Americans have CF. Roughly 1,000 new cases occur each year. 80 percent of patients are diagnosed by three.

Idiopathic pulmonary fibrosis is a condition in which the air sacs in the lungs become thickened and scarred, permanently reducing the ability of the lungs to exchange oxygen and carbon dioxide. The Pulmonary Fibrosis Foundation estimates over 200,000 Americans have the condition. Patients experience shortness of breath, dry cough and eventually, heart failure. The term, "idiopathic," means the symptoms can't be attributed to any detectable cause.

Primary pulmonary hypertension is caused by a progressive narrowing of the blood vessels in the lungs, leading to high blood pressure in the affected vessels. Patients may experience shortness of breath, fatigue, dizziness, weakness, fainting, chest pain, swelling of the ankles and a bluish coloring of the lips and skin. Eventually, heart failure occurs. The condition is believed to be relatively rare. The American Lung Association estimates 300 new cases are diagnosed each year.

Selecting Recipients

Survival rates for lung transplant patients are improving. Researchers estimate 83 percent of patients survive at least one year. More than 49 percent survive five or more years. However, there is still a critical shortage of donor lungs. As of July 24, there were 2,755 candidates on the waiting list for a lung transplant.

Traditionally, older patients have been passed over for lung transplantation. Transplant doctors have recommended an age limit of 65 for patients requiring a single lung transplant and 60 for those needing a double lung transplant. Mark Robbins, M.D., a Critical Care Specialist with the University of Virginia Health System, says the limits were placed because health experts have believed that older patients are at higher risk for heart complications. However, many of the conditions for which a transplant is needed occur in elderly people. Researchers estimate 25 percent of Americans will be 60 or older by 2030, increasing the need for transplants among older patients.

Researchers at the University of Virginia recently compared the outcomes of older and younger lung transplant patients. They found no significant differences in length of hospitalization, complications and patient survival rates between those under and those 60 and older. Even patients 65 and older had "excellent" survival rates.

David Jones, M.D., Lung Transplant Director, explains that older people tend to be in better health than their counterparts from ten or twenty years ago. At the University of Virginia doctors use physiologic age, rather than chronological age, to determine a patient's probable transplant success. All transplant patients are required to undergo a thorough medical and psychological evaluation, and an assessment of social support and financial ability to handle the costs of the transplant and follow-up care and medications.

For general information on lung transplants:

United Network for Organ Sharing (UNOS)

For information on lung diseases:

American Lung Association

National Heart, Lung and Blood Institute

Pulmonary Fibrosis Foundation