LUNG TRANSPLANT EVALUATION GUIDELINES

The comprehensive transplant evaluation seeks to determine the ability of the patient to benefit from transplantation and to enjoy a successful outcome with long-term good health.

Eligibility Criteria for Lung Transplant

Evaluation and selection of patients for transplantation is the result of a coordinated process, which looks at the whole patient. While you can be screened for basic eligibility outside the centre, a comprehensive evaluation will require a visit to the KIMS Heart and Lung Transplant Institute. Patients with end-stage lung disease requiring life support may be considered for inpatient transfer for urgent evaluation and listing, however, this is an exceptional circumstance and is guided and monitored by the organ allocation policy of, the regional organ allocation body that is governed and monitored by the Department of Health.

Evaluation is conducted in stages and is customized to efficiently address key issues that might prohibit transplantation in a particular patient. After the evaluation is completed, the patient’s case is discussed in the multidisciplinary transplantation-evaluation conference. A complete presentation is made, and opinions welcomed from all participants in the program. The decision about eligibility for transplantation is made with everyone’s consensus. 

Requirements for Candidacy

• The patient has a progressive, potentially fatal lung disease that substantially impairs the quality of life and daily function, and for which all alternative medical and surgical treatments short of lung transplantation have been exhausted.
  
• The patient’s lung disease is not expected to recur and cause disability within five years.
• The patient is not moribund, and the lung transplant is likely to prolong life for at least five years (with a five-year survival rate of over 50%) and the lung transplant will restore the patient to a range of physical and social function suitable for the activities of daily living.
• The patient does not any conditions or diseases of a major system (e.g., cardiovascular or that would preclude surgery or indicate a poor potential for rehabilitation.
• The patient’s psychological assessment, social arrangement, and family support indicate a reasonable expectation that the patient will adhere to the strict long-term medical regimen that will be required post-transplant.
• The patient has no active substance abuse.
• The patient has completed at least six months of documented rehabilitation and sobriety and has psychological clearance.
• The patient has demonstrated the severity of illness that merits a transplant and has no absolute contraindication to the procedure.
• The patient undergoes a comprehensive assessment, which is reviewed by the multidisciplinary transplantation committee.

Usually, we consider lung transplantation in persons with end-stage lung disease who are less than 65 years of age for a double lung or heart-lung transplant, and less than 70 for a single lung transplant. However, there is no absolute age contraindication and we consider patients based on their physiological age rather than the chronological age. However, long-term survival does favor younger patients as co-morbid illnesses increase with the aging process.