A lung transplant is recommended when medical therapies have been maximized. Still, severe dysfunction remains, which significantly impacts quality of life and life expectancy. It is not recommended for milder forms of the disease, when severe disease affects multiple organ systems, or as a treatment for lung cancer.
Candidates for referral to a lung transplant center are those that have been diagnosed with:
Cystic fibrosis (CF)
- Chronic obstructive pulmonary disease (COPD)
- Pulmonary fibrosis (scarring of the lung)
- Pulmonary hypertension (PAH or PPH increased pressure in the arteries of the lungs)
- Heart disease or heart defects affecting the lungs (may require a heart-lung transplant)
- Alpha-1-antitrypsin deficiency
- Scleroderma
- Sarcoidosis
Timing of the referral
When referring a patient for lung transplant, the earlier, the better. Waiting until a patient’s condition advances and their overall health declines may decrease their chances of being a suitable candidate for transplant.
Interstitial lung disease (ILD)
FVC <80% or DLCO <40% predicted based on PFTs.
- Any form of pulmonary fibrosis with any of the following over the past two years based on PFTs.
- Decline in FVC of 10% OR
- Decline in DLCO of 15% OR
- Decline in FVC of 5% with worsening symptoms or radiographic progression.
- Any oxygen need.
COPD
BODE 5 to 6 with additional risk factors.
- FEV1 20% to 25%.
- Frequent exacerbations.
- Poor quality of life.
- Deterioration despite maximal medical therapies and pulmonary rehab.
Recommended testing
There are several recommended tests to determine patient appropriateness for transplant referral. Many of these can be repeated to show disease progression and functional decline.
PFTs (Serial PFTs showing a decline in lung function are preferred to trend a patient’s condition.)
- 6-minute walk (including pre- and post-heart rate, oxygen saturation and distance)
- Chest CT
- Enrollment in a pulmonary rehab program
Optimizing patients for referral
To optimize your patient for lung transplant referral, the more items from the following list that are addressed or completed, the better.
Health care maintenance
Colonoscopy (For all patients 45 and older and for CF patients 40 and older)
- Dental exam (every six months)
- Dermatology skin check
- Mammogram (Annually for female patients over 50)
- Pap smear (Every three years for female patients over 21)
- Prostate exam (Annually for male patients over 50)
Immunizations
Ensure all CDC-recommended, age-appropriate vaccines have been administered, including:
- Influenza (annually)
- COVID-19 (annually)
- RSV
- COVID-19 (Complete initial series and booster doses)
- Hepatitis A and B
- Influenza (annually)
- MMR
- Pneumococcal
- TDAP
- Zoster recombinant or varicella
Other considerations
The ideal candidate will have a solid support system with an identified care partner available to provide care and transportation for the patient before and after transplant.
Some conditions prevent a patient from receiving a lung transplant.
Malignancy within the last two years with a high risk of recurrence.
Active substance use (includes smoking, vaping and any drug use).
Potential contraindications:
Advanced age.
- Severe obesity or malnutrition.
Why Nebraska Medicine?
Based on data collected from UNOS, there is a disparity for patients in rural communities gaining access to transplant resources. The Nebraska Medicine lung transplant team offers patients access to renowned specialists, exceptional care and support from pre-evaluation to long-term follow-up care. Lung patients benefit from the Nebraska Medicine multidisciplinary team of surgeons, physicians, respiratory therapists, psychologists, social workers, dietitians and nurses. These professionals guide patients through a comprehensive process and provide extraordinary care to patients and their families.
“Lung transplant gave me eight more years and saved my life. There is nothing that I want to do now that I can’t do. At the time, I was scared to death, but the team at Nebraska Medical Center made it so simple, and I had nothing to fear. The lung transplant team was phenomenal, why go anyplace else?”
- Donna Jacobsen, lung transplant recipient from rural Nebraska
Program Directors
Heather Strah, MD
Lung transplantation medical director
Aleem Siddique, MBBS
Lung transplantation surgical director
Physician referring service: 402.559.8529
lungtransplant@nebraskamed.com
NebraskaMed.com/Transplant/Lung