Lung Transplant Criteria

Lung transplantation is an established treatment option for various types of end-stage lung diseases. A lung transplant is generally recommended when there is a progressive respiratory failure despite maximal medical therapy and when the survival advantage becomes evident.

Can I Get a Lung Transplant?

For select patients, a successful lung transplant can improve their quality of life and can increase their life expectancy.

Commonly treated conditions include end-stage:

• Chronic obstructive pulmonary disease (COPD, emphysema, Alpha 1 antitrypsin deficiency)
• Pulmonary fibrosis (idiopathic and other restrictive lung diseases)
• Cystic fibrosis (CF) and other conditions in which the bronchi of the lungs are damaged (bronchiectasis)
• Pulmonary arterial hypertension (PAH)
• Other rare lung diseases

Prompt evaluation for a transplant is particularly important for patients with idiopathic pulmonary fibrosis (IPF), PAH, and CF with recent deterioration. Disease progression in these illnesses is often unpredictable and early consultation with the lung transplant team can help ensure the best possible outcome.

Criteria for lung transplantation may include:

• Advanced lung disease with limited 2-year survival
• Oxygen-dependent
• Age is generally 70 years or younger
• Ambulatory and/or potential for rehabilitation
• Abstinence from tobacco, substance and alcohol use
• Adequate psychosocial support
• No significant associated comorbidities

Once listed as a lung transplant candidate, the patient’s referring primary care physician, pulmonologist, and cardiologist continue to provide care while the patient waits for a suitable donor lung.

The number of patients who meet lung transplant criteria and could benefit from a lung transplant greatly exceeds the number of available donor lungs. Thus, the lung transplant waiting list at hospitals will vary.

Follow-up visits to Newark Beth Israel are scheduled at approximately 1- to 3-month intervals to monitor the candidate’s medical status.

Lung Transplant Disqualifications

A lung transplant may not always be the ideal treatment option for every patient. In addition to lung transplant criteria, there are conditions that will disqualify a patient from a lung transplant, including:

• Active or recent history of malignancy
• Acute medical instability
• Significant dysfunction of another major organ system that is not treatable
• Non-adherence to medical therapy or follow up
• Substance abuse or dependence
• Active infection (HIV and Hep C disease with viremia)
• BMI less than 12 or greater than 40
• Absence of adequate social support
• Severely limited functional status with poor rehabilitation potential
• Poor psychosocial support
• Coexisting coronary artery disease (CAD), chronic kidney disease (CKD), or cirrhosis

Conditions that may also disqualify patients for lung transplant include:

• BMI less than 15 or greater than 35
• Poorly-controlled psychiatric conditions
• Severe malnutrition
• Prior thoracic surgery
• Severe symptomatic osteoporosis

Lung transplant specialists will determine whether these conditions disqualify patients on a case-by-case basis.

Lung Transplant Waiting List

Once patients are placed on the waiting list, many factors can affect how long they will wait. These factors include:

• Availability of donor organs
• Blood type/antigen matching (ABO and HLA matching)
• Urgency of transplant based on illness severity
• Organ sizing

While on the lung transplant waiting list, patients at Newark Beth Israel Medical Center:

• Regularly attend follow-up appointments with their medical team
• Regularly communicate with their lung transplant coordinator
• Have access to ongoing lung transplant education and support

Patients are required to maintain their health while on the lung transplant waiting list. This includes:

• Performing necessary routine medical testing
• Notifying their lung transplant coordinator if they develop new health problems
• Carefully following the provided treatment plan

Patients are asked to stay within 4 hours traveling distance from the hospital at all times. When a donor is identified, a lung transplant coordinator will call the patient and instruct them to be at the hospital as soon as possible. While patients wait for their donor lung, the lung transplant team:

• Begins to prepare the donor lung for transplant
• Ensures the lung is a good match for the patient

Families can accompany patients until they go into surgery. The surgery begins when the donor's lung is prepared and the patient is ready.