The authors of an article published in JHLT Open in November 2026 explain that in the early days, heart-lung transplantation was the standard for pulmonary arterial hypertension, because doctors believed the heart was too damaged to recover. Since the 1990s, the approach has shifted to transplanting both lungs only, as experience has shown that an overloaded right side of the heart can recover once healthy lungs are in place. Lung-only transplantation also means shorter waiting times and a fairer use of scarce donor organs. This matters because the risk of dying on the waiting list is higher for people with pulmonary arterial hypertension and rises quickly the longer they wait.
The authors acknowledge the concerns that have been raised about the lung-only approach, which explain why heart-lung transplants are still used in some cases: failure of the right side of the heart, weakness of the left side, a high rate of early problems with the new lungs (primary graft dysfunction), and the difficulty of treating patients who also have structural heart defects. They show how each can be managed. For example, keeping patients on a heart-lung support machine for a few days after surgery protects the left side of the heart, and minor heart defects can be repaired during or after the transplant. The authors conclude that heart-lung transplantation should be kept for a small group of patients with major heart defects or hearts unlikely to recover.
Read more at this link on the JHLT Open
Citation
K. Hoetzenecker, L. Savale, Lung transplantation for severe PAH – How far can we go? Pro-lung transplantation, JHLT Open, Volume 14, 2026, 100701, ISSN 2950-1334, https://doi.org/10.1016/j.jhlto.2026.100701
Summary by Deger Kesimoglu, volunteer for the Alliance for Pulmonary Hypertension