Referral Process
Considerations When Referring for Lung Transplant
Transplant Eligibility Criteria:
- End-stage lung disease including pulmonary fibrosis, emphysema, pulmonary hypertension, Cystic Fibrosis, bronchiectasis, Eisenmenger's Syndrome
- Failure of medical therapy
- Oxygen dependency
- Minimal corticosteroids
- Adequate right ventricular and left ventricular function
- No significant co-existing illness
- Please note that patients who are ventilator dependent are not acceptable transplantation candidates. All transplantation candidates must be psychosocially stable. Former cigarette smokers may be considered after 6 months of smoking cessation, as documented with serial negative urine nicotine and cotinine screening.
Indications for Lung Transplant
- Chronic lung disease or pulmonary vascular disease for which no further medical or surgical therapy is available and survival is limited.
Absolute Contraindications for Lung Transplant
Factors which place individual at highest risk for poor outcome, poor quality of life or increased mortality
- Ventilator dependence
- Active malignancy
- Active severe infection (Note: cystic fibrosis patients are always colonized)
- Severe irreversible hepatic or renal dysfunction that is not amenable to transplant
- Active smoker
- Severe peripheral vascular disease
- History of frank non-compliance to medical regime
- Active substance abuse and/or severe psychiatric dysfunction
- Severe coronary disease not amenable to intervention
- Lack of adequate social support
Relative Contraindications for Lung Transplant
Factors which place individual at higher risk for poor outcome, poor quality of life or increased mortality
- Severe esophageal dysmotility
- Diabetes mellitus with end-stage organ involvement
- Systemic disease that would limit the patient's long-term survival; e.g. connective tissue disease
- Weight consideration, BMI>30, BMI<17
- History of malignancies
- Chronic corticosteroid therapy
- Osteoporosis
- Prior thoracic surgery
- Ventilator dependence
- Active malignancy
- Active severe infection (Note: cystic fibrosis patients are always colonized)
- Severe irreversible hepatic or renal dysfunction that is not amenable to transplant
- Active smoker
- Severe peripheral vascular disease
- History of frank non-compliance to medical regime
- Active substance abuse and/or severe psychiatric dysfunction
- Severe coronary disease not amenable to intervention
- Lack of adequate social support
