Referral Process

Referral Form PDF

Considerations When Referring for Lung Transplant

Transplant Eligibility Criteria:

• Single Lung Transplantation
• Age less than 65 years
• End-stage pulmonary fibrosis, emphysema, possibly pulmonary hypertension
• Failure of medical therapy
• Medical disability
• Oxygen dependency
• Minimal corticosteroids within the preceding month (≤ 0.2 mg KG; i.e. 10-15 mg/d)
• Adequate right ventricular and left ventricular function
• No significant co-existing illness
• Double Lung Transplantation
• Age less than 50 years (relative)
• Cystic Fibrosis, Bronchiectasis, emphysema, pulmonary hypertension
• Failure of medical therapy
• Medical disability
• Oxygen dependency
• Minimal corticosteroids within the preceding month
• Adequate right ventricular and left ventricular function
• No significant co-existing illness
• Heart-Lung Transplantation
• Age less than 45 years (relative)
• End-stage pulmonary vascular disease (i.e. Primary Pulmonary Hypertension or Elsenmenger’s Syndrome)
• Inadequate right and/or left ventricular function to qualify for single or double lung transplantation
• Failure of medical therapy
• Medical disability
• Oxygen dependency (for primary lung disease)
• Minimal corticosteroids within the preceding month
• No significant co-existing illness
• Please note that patients who are ventilator dependent and/or have a tracheostomy are not acceptable transplantation candidates. All transplantation candidates must be psychosocially stable. Former cigarette smokers may be considered after 12 months of smoking cessation. Patients may be referred by calling 404-727-9560.

"International Guidelines for the selection of Lung Transplant Candidates" American Journal of Respiratory Critical Care Medicine 158:335-339, 1998. www.atsjournal.org

Indications for Lung Transplant

• Chronic lung 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

• Severe dysfunction of major organs other than the lung, particularly kidney, liver, heart or bone marrow
• Infection with HIV
• Hepatitis B antigen positivity
• Hepatitis C infection
• Active malignancy with past 2 years with exception of basal call and squamous cell carcinoma of skin; within 5 years for extracapsular renal cell turmors, breast cancer stage 2 or higher, colon cancer staged higher than Dukes A and melanoma level III or higher
• Colonization with B. cepacia (cystic fibrosis patients)

Relative Contraindications for Lung Transplant

Factors which place individual at higher risk for poor outcome,
poor quality of life or increased mortality

• Symptomatic osteoporosis
• Severe musculoskeletal disease affecting the thorax
• Obesity or malnutrition
• Active or untreated substance abuse
• Psychosocial problems which increase the likelihood of non-compliance by the patient
• Mechanical invasive ventilation for acute respiratory failure
• Colonization with resistant microorganisms.

Transplant Center