Practice Patterns and Attitudes Regarding Pregnancy and Parenthood After Lung Transplantation

Abstract

Background. Parenthood after lung transplantation (LuTx) is uncommon. Although data exist regarding practice patterns surrounding pregnancy after heart transplantation, there are no data specific to LuTx recipients and parenthood more broadly. Methods. We conducted a voluntary, anonymous online survey between October and December 2021. It was distributed electronically to select LuTx units and advertised to LuTx providers internationally. Results. A total of 103 responses were included in our analysis. Respondents were primarily women (n = 63; 62%) and included LuTx pulmonologists (n = 59; 58%) or nurses and transplant coordinators (n = 28; 27%). The majority were from centers performing >40 LuTx annually (n = 53; 52%) and had >10 y of transplant experience (n = 56; 55%). Most respondents discuss fertility issues with recipients (n = 63; 62%), but centers lacked clear policies relating to female (n = 51; 70%) and male (n = 62; 83%) fertility and parenthood. Few were aware of policies regarding assisted reproduction and fertility preservation (n = 13; 13%) or pregnancy (n = 23; 22%). Many cited ethical concerns regarding parenthood post-LuTx (n = 38; 37%), but most were supportive of the use of surrogacy by female recipients (n = 74; 92%) and felt there were no contraindications to parenthood in male recipients (n = 59; 59%). Although geography influenced some logistical issues around care provision, general attitudes toward parenthood in LuTx recipients were unaffected by respondent age, sex, location, or experience. Conclusions. Although providers were overall supportive of post-LuTx parenthood, the absence of peer-reviewed evidence, expert consensus, and policy-driven guidance may be a significant barrier to safe and successful parenthood in LuTx recipients.