NHS-commissioned · UK-wide
Lung transplantation in the UK, what the pathway actually looks like.
Single or bilateral lung transplantation for end-stage lung disease - commissioned by NHS Blood and Transplant, delivered at six adult centres, and around 200 UK transplants a year. Here is what to expect.
Why patients read this page
- 01
One of six adult UK centres, by referral
Lung transplantation is commissioned by NHS Blood and Transplant across six adult centres. We help you understand which centre and why.
- 02
A clear read of your assessment
What the MDT is looking for, what the numbers mean, and what puts you on - or off - the active waiting list.
- 03
Independent, and free
Lung transplantation is NHS-funded, not private. Our role is to translate, not to sell - the guidance costs you nothing.
Cost and access
Lung transplantation is NHS-funded, not private.
The operation itself is delivered by NHS Blood and Transplant. Private care can speed up second opinions and pre-referral work-up - it cannot short-cut the transplant list.
In short
The transplant itself: no patient cost. Median wait: 4–6 months.
| Item | Indicative range | Duration | Pathway |
|---|---|---|---|
| Lung transplantation (NHS-funded) | No patient cost | 6–12 h theatre | NHS pathway |
| Formal transplant assessment (NHS) | No patient cost | ~1 week inpatient | MDT decision 2–4 weeks |
| Private respiratory second opinion | £300–£600 | 45–60 min | Same visit |
| Private pulmonary function tests | £350–£700 | 60 min | 1–3 days |
| Private HRCT chest | £450–£900 | 15–30 min | 1–3 days |
| Private cardiopulmonary exercise test | £600–£1,100 | 60–90 min | 3–7 days |
Around 200 lung transplants are performed in the UK each year across Papworth, Royal Brompton and Harefield, Newcastle, Manchester Wythenshawe, Birmingham (and Great Ormond Street for paediatric). Private lung transplantation is not an established UK pathway.
The problem
The right referral, the right timing, the right expectations.
Lung transplantation is one of the most complex decisions in respiratory medicine. Referred too late, the window closes; referred too early, patients wait unnecessarily. Understanding the criteria matters.
-
Not sure if you should be referred?
FEV1 under 25%, DLCO under 39%, oxygen dependence or rapid decline - any one of these is a reason to talk to your respiratory team about referral.
-
Worried about the wait?
Median wait is 4 to 6 months but blood group, body size and antibody status all matter. The transplant coordinator will explain your realistic timeline.
-
Want to know what life looks like after?
Lifelong immunosuppression, monthly clinics, home spirometry - but also the dramatic relief of breathlessness that makes it worth it.
The pathway
From referral to lifelong follow-up - what happens, in order.
A structured NHS pathway. One transplant coordinator through assessment, listing, transplantation and beyond.
Phase 1 · Referral and assessment
MDT decision on suitability
Phase 2 · The transplant
The call, theatre, and ITU
Phase 3 · Lifelong
Rehab and follow-up
- 01
Before
Referral from your respiratory team
Your consultant refers you when disease is advanced - FEV1 under 25% predicted, DLCO under 39%, oxygen dependence, frequent admissions, or rapid decline.
- 02
Before
Formal transplant assessment
A week or so at the transplant centre - imaging, lung function, echo, right heart catheter, tissue typing, psychology, dietitian, physiotherapy.
- 03
Before
MDT decision and listing
The multidisciplinary team decides suitability. If accepted you go on the NHSBT active waiting list - median 4 to 6 months, sometimes over two years by blood group and antibody status.
- 04
The transplant
The call and admission
A donor lung is offered. You come in, are re-checked, consented, and taken to theatre - often within hours of the call.
- 05
The transplant
The transplant itself
A 6 to 12 hour operation. Single lung via thoracotomy, or double lung via clamshell incision - often on cardiopulmonary bypass. Ex-vivo lung perfusion may have prepared the donor lung.
- 06
The transplant
Straight to intensive care
Ventilated in ITU for around 7 to 14 days, with chest drains, invasive monitoring, and the first doses of immunosuppression.
- 07
After
Ward, rehab and lifelong follow-up
Four to eight weeks in hospital, intensive pulmonary rehab, then weekly clinic tapering to monthly and annual - with surveillance bronchoscopy and CT for rejection and CLAD.
Referral to listing: 2–4 months. Median wait on list: 4–6 months (up to 2+ years by blood group).
Who it is for
When lung transplantation is the right conversation.
The conditions we most commonly see referred, plus the red flag that means an emergency rather than an outpatient discussion.
-
COPD and emphysema
The single most common indication in the UK. Referral is usually considered once FEV1 falls below 25% predicted with breathlessness at rest.
-
Idiopathic pulmonary fibrosis (IPF)
Progressive scarring. DLCO under 39% predicted, or a rapid decline over 6 to 12 months, prompts early referral before the window closes.
-
Cystic fibrosis and bronchiectasis
Chronic infection with frequent admissions, oxygen need or worsening lung function - bilateral transplantation is the standard here.
-
Alpha-1-antitrypsin deficiency
A genetic emphysema that behaves like severe COPD, often at a younger age - assessed on the same physiological criteria.
-
Pulmonary arterial hypertension (PAH)
When targeted PAH therapy fails to control right heart strain, bilateral or heart-lung transplantation is considered.
-
LAM and end-stage sarcoidosis
Rarer indications - lymphangioleiomyomatosis, end-stage pulmonary sarcoidosis and other advanced interstitial disease.
-
Rapid decline or repeated admissions
Falling lung function over 6 to 12 months, increasing exacerbations and hospitalisations - a signal to refer sooner rather than later.
-
Red flag: acute respiratory failure
Sudden decompensation, rising oxygen need or hypercapnia is an emergency - 999 or A&E, not a clinic booking.
Types of transplant
Not every lung transplant looks the same.
Single, bilateral, heart-lung - plus the ancillary techniques (EVLP, bypass, ECMO bridging) that make modern lung transplantation possible.
-
Single lung transplant (SLT)
One donor lung via posterolateral thoracotomy. Historically used for COPD and IPF - simpler, uses one donor lung.
-
Bilateral (double) lung transplant (BLT)
Both lungs replaced via clamshell incision. Standard for CF, bronchiectasis and PAH - now often preferred for COPD and IPF too, with better long-term outcomes.
-
Heart-lung transplantation
Rare - reserved for Eisenmenger syndrome and complex congenital heart disease where the heart cannot be spared.
-
Lobar transplantation
A donor lobe rather than a whole lung. Limited use, mostly paediatric or size-mismatched adults.
-
Ex-vivo lung perfusion (EVLP)
Not a different transplant - a technique that ventilates and perfuses a donor lung outside the body, extending viability and enlarging the donor pool.
-
Cardiopulmonary bypass
Used for bilateral transplants and pulmonary hypertension cases. Some single lung transplants are done off-pump.
-
Bridge to transplant
ECMO or invasive ventilation to keep patients alive on the list. A specialist decision - not all centres and not all diseases.
-
Not a transplant
For selected COPD there is lung volume reduction surgery - different operation, different physiology, sometimes done first.
The UK transplant centres
Six adult centres, one national list.
Papworth, Royal Brompton and Harefield, Newcastle, Manchester Wythenshawe and Birmingham - with Great Ormond Street for paediatric cases. NHSBT coordinates the waiting list nationally.
What good care looks like
The standards every UK transplant patient should expect.
-
Referral to one of the six UK adult centres (Papworth, Royal Brompton and Harefield, Newcastle, Manchester Wythenshawe, Birmingham; Great Ormond Street for paediatric)
-
Formal multidisciplinary assessment against ISHLT and UK national listing criteria
-
A named transplant coordinator through assessment, listing and post-transplant care
-
Structured pulmonary rehabilitation before and after transplantation
Safety and outcomes
What to expect afterwards - honestly.
Lung transplantation is life-transforming, but it is not a cure. Understanding the early complications, the long-term risks and the daily commitment is the price of a good outcome.
-
Primary graft dysfunction (PGD)
Injury to the new lung in the first 72 hours. Grade 3 PGD is severe and carries the worst early outcomes - the reason for the long ITU stay and cautious ventilation.
-
Anastomotic complications
Where the airway is joined - bronchial dehiscence or stricture. Strictures are usually managed with a bronchoscopic stent or dilatation.
-
Acute rejection
Common in the first year. Detected on surveillance bronchoscopy and biopsy, treated by adjusting immunosuppression - usually reversible if caught early.
-
Infection risk is real and lifelong
Bacterial, CMV, Pneumocystis and aspergillus are the ones we watch for. Prophylaxis matters - Septrin lifelong, valganciclovir for months, nebulised antifungals as directed.
-
Chronic lung allograft dysfunction (CLAD)
The leading cause of late death - either bronchiolitis obliterans (BOS) or restrictive allograft syndrome (RAS). Surveillance lung function picks it up early.
-
Immunosuppression side effects
Tacrolimus and mycophenolate keep the lung alive but bring diabetes, kidney impairment, cardiovascular risk, osteoporosis and skin cancer. Regular monitoring is non-negotiable.
-
Outcomes are life-transforming - and finite
One-year survival is around 85% and five-year 55 to 60%. Median survival is 6 to 7 years - lower than kidney or liver, but with dramatic relief of breathlessness.
-
Adherence and vigilance are part of the deal
Daily immunosuppression, home spirometry, sun protection, vaccinations and rapid response to symptoms - the difference between good outcomes and avoidable loss.
-
Red flags after transplant
New breathlessness, a fall in home spirometry, fever, productive cough or chest pain - call the transplant coordinator the same day, not the next week.
Reading your operation note
Your transplant note in four parts. Read the last one first.
Whichever centre you were transplanted at, the discharge summary keeps to the same shape.
A quiet reminder
Transplant language is precise - we translate it for you.
If you would like us to talk you through the discharge summary before your first outpatient review, just ask.
- 01 Header
Indication, listing and donor summary
Why you were listed, blood group and antibody status, and a short description of the donor lung and any ex-vivo perfusion used.
- 02 Technique
Operation and anaesthetic
Whether it was single or bilateral, the incision, whether cardiopulmonary bypass was used, and the ischaemic time for the graft.
- 03 Findings
Intraoperative findings and early ITU
Notes on anastomoses, PGD grade in the first 72 hours, and any early complications addressed in intensive care.
- 04 Impression
Immunosuppression, follow-up and red flags
Read this first: your immunosuppression regimen, prophylaxis (Septrin, valganciclovir, antifungal), surveillance schedule, and when to call the coordinator.
Recognised by major UK insurers
Lung transplantation itself is NHS-funded. Private cover is only relevant for second opinions, pre-referral tests and ancillary care. We help you use it well.
Frequently asked
Everything patients ask about lung transplantation.
Quick answers on eligibility, the waiting list, the operation, recovery and what long-term life looks like.
-
Is lung transplantation available privately in the UK?
No - not routinely. UK lung transplantation is commissioned by NHS Blood and Transplant and delivered at six adult centres. Private lung transplantation is not an established pathway; private care is limited to second opinions, tests and assessment support.
-
Who is a candidate for a lung transplant?
Adults with end-stage lung disease - most often COPD, IPF, cystic fibrosis, alpha-1-antitrypsin deficiency, pulmonary hypertension or advanced bronchiectasis - where medical therapy has been exhausted and predicted survival without transplant is limited. Detailed criteria follow ISHLT and UK national guidance.
-
What stops someone being listed?
Active malignancy (usually a five-year cancer-free window), active untreated infection, severe dysfunction of other organs, morbid obesity (BMI over 35 is often a relative bar), active substance misuse, poor adherence, severe frailty, or extensive prior thoracic surgery. Each centre weighs these individually.
-
What is the difference between a single and a double lung transplant?
A single lung transplant replaces one lung - historically used for COPD and IPF. A bilateral (double) lung transplant replaces both and is standard for cystic fibrosis, bronchiectasis and pulmonary hypertension. Many centres now prefer bilateral for COPD and IPF too, because long-term outcomes tend to be better.
-
How long is the waiting list?
Around 200 to 300 patients are actively listed in the UK at any time. Median wait is 4 to 6 months, but can exceed two years depending on your blood group, body size and antibody status. Mortality on the waiting list is around 15 to 20%.
-
What does the operation involve?
A 6 to 12 hour operation. Single lung transplant uses a posterolateral thoracotomy; bilateral uses a clamshell incision or bilateral thoracotomies. Cardiopulmonary bypass is usual for bilateral and PAH cases. Ex-vivo lung perfusion may have been used to assess and improve the donor lung before implant.
-
What is recovery like?
Seven to fourteen days in intensive care, four to eight weeks in hospital, then structured pulmonary rehabilitation. Weekly clinic tapers to monthly and annual, with surveillance bronchoscopy and CT for rejection and chronic lung allograft dysfunction.
-
What are the long-term outcomes?
One-year survival is around 85% and five-year survival 55 to 60%. Median survival is 6 to 7 years - lower than kidney or liver transplantation, but with dramatic relief of breathlessness. Younger patients and bilateral transplants for cystic fibrosis tend to do best.
Related treatments