喵咪社区

A 喵咪社区 expert explains the eligibility and evaluation processes.

If you or a loved one is dealing with severe lung disease, a lung transplant may be an option. Understanding the process of getting on a lung transplant waiting list is an important first step in this journey. 

鈥淟ung transplantation exchanges the whole lung for a new lung,鈥� explains Takashi Harano, MD. Dr. Harano is a thoracic and lung transplant surgeon with the 喵咪社区 Lung Transplantation Program, part of the 喵咪社区 Transplant Institute and 喵咪社区.  

Lung transplants, though rare, are becoming more common. In 2023, lung transplants exceeded 3,000 for the first time in the United States and rose to in 2024, according to the United Network for Organ Sharing.  

What to know about a lung transplant聽

A lung transplant is reserved for patients with end-stage lung disease who have exhausted other treatment options. Patients must take lifelong anti-rejection medications afterward. 

The most common condition leading to lung transplantation is pulmonary fibrosis, a condition in which stiffened lung tissue prevents proper breathing. This progressive condition has no cure, Dr. Harano explains. 

Other qualifying conditions include chronic obstructive pulmonary disease (COPD), cystic fibrosis, pulmonary hypertension and severe bronchiectasis. 

Who is eligible for a lung transplant?聽

The journey begins when a patient鈥檚 condition worsens despite optimal therapy. 鈥淲hen the patient starts struggling with breathing and starts using supplemental oxygen, a pulmonologist, or lung specialist, may introduce the patient to the idea of lung transplantation,鈥� Dr. Harano says. 

A general pulmonologist will then typically refer a patient to a specialized lung transplant center 鈥� the first official step in transplant evaluation. A multidisciplinary team including transplant pulmonologists, surgeons, physical/occupational therapists, social workers, pharmacists and dieticians evaluate the patient鈥檚 case. They assess all medical and social aspects to decide whether the patient will be a good candidate for a lung transplant. 

To qualify for a lung transplant, patients must: 

• Have end-stage lung disease聽
• Have exhausted other treatment options聽
• Be physically fit aside from their lung disease. (Well-controlled conditions such as diabetes and hypertension are not disqualifiers.)聽
• Not have severe disease in other organs. (If there are any concerns regarding the health of other organs, the medical team will carefully assess the need for dual-organ transplantation, such as heart and lung, lung and liver, or lung and kidney, Dr. Harano says.)聽

While there is no absolute age cutoff for eligibility, Dr. Harano says patients over 70 may face more selective criteria. Patients must also be substance-free (no smoking, alcohol, vaping, marijuana, etc.) for at least six months. 

Having a strong support network is also critical to a patient鈥檚 transplant success. This support system helps navigate the challenges of post-transplant life, including medication management and follow-up appointments. 

Insurance approval is also essential. Most transplant centers work with patients鈥� insurance companies for preauthorization before proceeding. 

The lung transplant evaluation process聽

Transplant evaluation involves numerous tests to assess a patient鈥檚 overall health and suitability for transplant: 

• Blood tests for organ function, infectious status and immunizations (must be up to date)聽聽
• Heart health tests, including echocardiogram and cardiac catheterization聽
• Imaging studies (CT scans of the head, chest and abdomen)聽
• Vascular assessment of the neck聽
• Pulmonary function tests聽
• Exercise capacity tests (six-minute walk test)聽
• Swallowing assessment to check for the risk of accidentally inhaling food or liquid聽

The evaluation process typically takes three to six months, but 鈥渋f patients are getting very sick, we complete their evaluation as inpatients and can finish it within a week,鈥� Dr. Harano adds. 

Getting added to a lung transplant waiting list聽

Transplant patients receive a composite allocation score (CAS) determining their priority for available organs. The CAS considers medical urgency, expected benefit from a transplant, physical distance from the donor, and compatibility factors. 

Medical urgency is a primary factor. 鈥淚f the patient requires a higher amount of supplemental oxygen, they can be prioritized to get a lung transplant more quickly,鈥� Dr. Harano notes.  

Patients with acute illnesses like flu are temporarily removed from the waiting list until they recover because they can鈥檛 safely undergo transplant surgery while sick. However, if the patient is getting sick from their lung disease, they can remain on the list as a candidate. Dr. Harano says these candidates are supported with a ventilator or even extracorporeal membrane oxygenation (ECMO, also known as a 鈥渉eart-lung machine鈥�). Candidates can also be dual listed at another transplant center, but this might only work in their favor if the two centers are located in different regions.  

Life on the lung transplant waiting list聽

As they wait, lung transplant candidates should try to keep themselves as healthy as possible. 鈥淭he most important thing is engaging in whatever physical activity they can do,鈥� Dr. Harano emphasizes. Many patients work with physical therapists to develop safe exercise programs that they can engage in despite their breathing difficulties. 

Close communication with your transplant coordinator is critical, he adds. Report any changes in your condition promptly to ensure your listing status reflects your current needs. 

Waiting times vary based on medical urgency 鈥� from days for the critically ill to six months or even a year for more stable cases. 

During the emotionally challenging wait, transplant centers like the 喵咪社区 Transplant Institute offer monthly support meetings organized by social workers. In addition to supporting patients before transplantation, these groups lend support after transplantation, providing ongoing teaching and a place where patients can share their experiences within the Keck Medicine transplant community.  

When an organ becomes available, be ready to come to the hospital quickly. Keep your phone accessible, have transportation arranged, have a packed bag ready and have an updated medication list. 

Your transplant journey takes off聽

Getting added to a lung transplant list requires careful evaluation and preparation. By understanding the process, you can position yourself for the best possible outcome. 

鈥淲e always keep encouraging patients that there is hope that they could get a transplant,鈥� says Dr. Harano.

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