Refer Your Patient
To refer a patient for lung transplant evaluation or to speak with a member of our staff, please call 404-727-9651 Monday through Friday from 8 a.m. to 4:30 p.m.
The following items are required for a lung transplant referral to be processed:
• Completed Referral Form (PDF 100 KB)
• A dictated progress note or History & Physical which summarizes the patient’s course and care, and includes a complete list of relevant past medical history
• Recent pulmonary function testing
• Radiologic films and reports (Chest X-ray, CT of the chest, bone density studies, etc.)
• Pathology and Operative reports, where applicable
• Cardiac catheterization reports, where applicable
• Patient’s smoking history and documentation of cessation, if applicable
• Notes from any other transplant centers that have seen the patient
• Notes from any consulting physicians that have seen the patient.
• A signed consent to obtain outside medical records
• Copy of front and back of patient's insurance card
These items can be faxed to 404-727-1516. Faxed referral information will be reviewed by a transplant pulmonologist. If your patient has contraindications to transplantation, the transplant pulmonologist will contact you to discuss the patient’s case.
- Age 16 to 70+ years (patients greater than age 65 are evaluated on a case-by-case basis)
- Functionally limited (NYHA class III or IV) but still ambulatory with rehabilitation potential – patients hospitalized in ICU with critical or unstable clinical condition may become candidates once discharged home and ambulatory
- Willingness to adhere to guidelines from health care professionals
- Early referral is highly desirable, particularly in idiopathic pulmonary fibrosis
Indications for Lung Transplant
- End-stage lung diseases without adequate response to optimal treatment
- Predicted two- to three-year life expectancy of less than 50%.
Absolute Contraindications for Lung Transplant
- Ventilator dependence
- Recent malignancy (other than nonmelanoma skin cancer) in the past two to five years
- Significant extrapulmonary vital organ dysfunction (irreversible hepatic, renal, cardiac dysfunction, bone marrow failure)
- Severe coronary disease not amenable to intervention; severe peripheral vascular disease
- Noncurable chronic extrapulmonary infection including chronic active viral hepatitis B, hepatitis C or HIV
- Active infection with mycobacteria, B. cenocepacia (genomovar III) and B. gladioli
- Substance addiction (e.g., alcohol, tobacco, narcotics) – active or within the last six months
- Severe psychiatric illness
- Inability to cooperate or comply with medical therapy
- Lack of adequate social support
- Obesity (BMI > 30) or underweight (BMI < 17) is relative contraindication
Referral for lung transplantation is recommended by international guidelines if patients meet any of the following criteria (The Journal of Heart and Lung Transplantation 2006, 25:745-755).
COPD
• BODE index exceeding five
• Deterioration despite optimal medical and surgical therapy
• History of hospitalization for exacerbation associated with acute hypercapnia (PCO2 exceeding 50 mm Hg)
• Pulmonary hypertension or Cor pulmonale or both, despite oxygen therapy
IPF
• Histologic or radiographic evidence of UIP irrespective of vital capacity
• Histologic evidence of fibrotic NSIP
CF
• FEV1 below 30% predicted or a rapid decline in FEV1 – in particular in young female patients
• Exacerbation of pulmonary disease requiring ICU stay
• Increasing frequency of exacerbations requiring antibiotic therapy
• Refractory and/or recurrent pneumothorax
• Recurrent hemoptysis not controlled by embolization
IPAH
• NYHA functional class III or IV, irrespective of ongoing therapy
• Rapidly progressive disease
Sarcoidosis, LAM, Eosinophilic Granuloma
• NYHA functional class III or IV
