The health status of the Norwegian Crown Princess Mette Marit has “deteriorated significantly,” the royal court announced on Tuesday. She has stopped attending appointments since January 28, 2026.

Official palace spokeswoman Sara Svanemyr told the Norwegian magazine “Se og Hear”: “As is known, the Crown Princess suffers from the chronic disease pulmonary fibrosis. As we announced in December, the Crown Princess’s health has recently deteriorated significantly and preparations have been initiated for a possible lung transplant.”

If the fibrosis has already progressed, is getting worse and, as is now the case with Mette-Marits, all treatment options have been exhausted, the patients are referred to a transplant center. During a transplant, one or both lungs are replaced.

However, the wait for a donor lung can be lengthy due to the low availability. As from numbers of the Federal Institute for Public Health shows that 308 lung transplants were carried out in Germany in 2025. At the end of the year, 323 patients were still on a waiting list.

Requirement for a lung transplant

According to the health portal, to be eligible for a transplant, the patient must “Lung Information Service” from the Helmholtz Munich Research Center meet certain requirements. These include:

• stable state of health
• no serious concomitant diseases such as tumors, blood poisoning or the failure of other organs
• no tobacco use and alcohol or drug abuse
• Reassurance to take immunosuppressive medications for life and attend follow-up visits

Selection of patients

When a patient is selected for a transplant depends on various factors. In general, the so-called lung allocation score (LAS) assesses how urgent a transplant is for the patient and how successful it will be. He is responsible for the allocation of a donor lung.

Crucial factors that are taken into account are, for example:

• Old
• Size
• Weight
• Blood type
• Type of lung disease
• Severity of pulmonary dysfunction
• Oxygen requirement

The higher a patient’s LAS score, the better their placement on the waiting list. As soon as the person has been placed on the waiting list, the search for a suitable organ begins.

The Eurotransplant headquarters in the Netherlands, where everyone waiting for a transplant is registered, is responsible for coordinating the allocation of donor organs in several European countries.

How the operation works

During a lung transplant, the patient’s chest is surgically opened. First, a diseased lung or the diseased lung is removed. The donor organ is then connected to the patient’s main bronchi, pulmonary veins and pulmonary artery. Meanwhile, ventilation takes place via the second lung. If necessary, the other lung is then transplanted.

The patient is then taken to the intensive care unit under ventilation. If things go normally, he can leave the hospital after three weeks.

What complications can occur

According to the “Lung Information Service”, a lung transplant is a safe and established procedure, but is associated with a high risk of complications. Almost one in three patients experiences episodic acute rejection in the first year after the transplant, which leads to inflammatory reactions in the small blood vessels of the lungs. The affected person then receives a higher dosage of immunosuppressants to avoid rejection.

However, medications that suppress the immune system increase the risk of infections with bacteria, viruses and fungi. In addition, the seams where the donor lung is connected to the patient’s bronchial system can lead to narrowing of the airways. Degradable stents can help against this.

Chronic graft failure

The most important long-term complication of a lung transplant is chronic transplant failure – rejection of the donor organ, whereby the lung tissue becomes scarred and lung function deteriorates again. This affects every second patient within the first five years after the transplant, and even three out of four patients within the first ten years.

The causes of transplant failure have not yet been conclusively clarified; risk factors include tissue injuries caused by the transplant and inflammation. With the help of medication, attempts can be made to prevent or slow down transplant failure. If this does not succeed, the lung is destroyed – and a new transplant is necessary.

Survival rate after ten years

According to the International Society for Heart and Lung Transplantation, survival rates after a transplant are as follows:

• after three months: 89 percent
• after one year: 80 percent
• after five years: 53 percent
• after ten years: 32 percent

Compared to transplantation of other organs, survival rates for a lung transplant are low. This is due, among other things, to the older age (average 55 years) and other serious illnesses of the patients.

However, survival rates have been increasing in recent years. The “Lung Information Service” also points out that these are average values. “A lung transplant usually brings with it an enormous increase in quality of life. Many transplant recipients find the ability to breathe easily to be a major gain,” it says.