Most Searched
Originally published August 25, 2025
Last updated March 21, 2026
Reading Time: 7 minutes
Search more articles
News & Magazine
Topics
For most patients in dire need of an organ transplant, a transplant is their only hope of survival. Unfortunately, too often patients 鈥� especially those with advanced lung diseases like chronic obstructive pulmonary disease (COPD), pulmonary hypertension and pulmonary fibrosis 鈥� are referred to a transplant center after the window of opportunity for a transplant has closed.
Sivagini Ganesh, MD, is raising awareness about this ongoing problem. Ganesh is a pulmonary critical care specialist and medical director of the 喵咪社区 Lung Transplantation Program, part of the 喵咪社区 Transplant Institute and 喵咪社区. The 喵咪社区 Transplant Institute also provides advanced heart, liver and lung transplant care and complex hepatobiliary care to patients living in Southern Nevada at its state-of-the-art facility 喵咪社区 鈥� Las Vegas.
There are several reasons why some community physicians don鈥檛 refer severe lung disease cases to a transplant center early enough, Ganesh says.
Many will first try to exhaust all other treatment options 鈥� primarily medication. For instance, they may try inhaled medications, or even new medications for pulmonary fibrosis, and wait to see if these help. Unfortunately, they may wait too long before moving to the inevitable: a lung transplant.
鈥淭heir approach is to treat the patient as long as they can,鈥� Ganesh says. 鈥淲hen everything else fails, only then will they refer the patient for a transplant.鈥�
Some physicians additionally aren鈥檛 familiar enough with the transplant process to recognize the opportune point of referral. 鈥淢any physicians in the community are not exposed to the world of transplant during their training, and that鈥檚 another reason patients don鈥檛 get referred on time,鈥� she says.
鈥淲hat they should understand, however,鈥� she continues, 鈥渋s that when they refer a patient too late, the patient may be declined for a transplant because by that time the patients are too sick to be transplanted.鈥�
When is the ideal time to refer a patient? Ganesh describes the 鈥済ood window.鈥�
鈥淧atients should be able to walk around and be physically functional,鈥� she says. 鈥淭hey should be able to carry out tasks of daily living and also be able to manage their medication.鈥�
By contrast, 鈥淲hen patients are bed-bound and needing high amount of oxygen, physically deconditioned and unable to get out of bed and in complete need of assistance, a transplant is not going to be successful.鈥�
She adds that the has established guidelines for how to manage patients with advanced heart and/or lung disease 鈥� including when to refer patients for a transplant.
Many steps, and a lot of time, precede getting a patient listed on a lung transplant wait list.
鈥淭he referral process starts when a pulmonologist, internal medicine physician or even a cardiologist encounters a patient with end-stage lung disease like COPD, lung fibrosis, bronchiectasis or pulmonary hypertension,鈥� Ganesh says. 鈥淭hese patients need significant amount of support, and when their physician feels their condition is medically not manageable, they鈥檒l refer them for a transplant.鈥�
The transplant center then works to obtain financial clearance from the insurance company to start evaluating the patient. Evaluation is extensive and includes all organ systems, which usually takes months for completion.
Ganesh explains that the time required for testing can differ depending on whether a patient is an inpatient or an outpatient. For inpatients, testing takes a full week to complete.
Most insurance companies, however, require patients to be treated as outpatients due to cost. For outpatients, testing can take anywhere from three to six months to complete due to the number of tests required and the ability of a patient with poor lung function to come to the testing place. 鈥淚f you order multiple tests for an outpatient, the patient must go back and forth to the hospital for testing,鈥� Ganesh says.
鈥淚f possible,鈥� she says, 鈥渨e prefer to do an inpatient workup because these patients who need a transplant are already sick and on five or six liters of oxygen. As outpatients, commuting to and from the hospital can be very challenging for them. If they are an inpatient, we do all the testing needed within seven days and then move the patient to the next level, which is listing.鈥�
Doctors and patients should be aware of the potentially long testing time. 鈥淧atients and their doctors need to anticipate enough time in advance for the testing to be done, especially for outpatients,鈥� Ganesh advises.
If a patient is very ill, on rare occasion a transplant center may be able to convince an insurance company that the patient needs to be admitted as an inpatient, but this doesn鈥檛 always work. Other times, if a patient is sent to an outside hospital because they are too sick, there鈥檚 a chance that an insurance company may eventually agree to have the patient transferred to a transplant center as an inpatient. It鈥檚 always a gamble, however.
鈥淯nfortunately,鈥� Ganesh says, 鈥渟ome patients will pass away before they get to listing because they are very sick.鈥�
For patients who do complete testing, their case will be discussed in a multidisciplinary meeting to determine whether the patient would be a good transplant candidate. 鈥淲e all meet together: the pulmonologist, the surgical teams, physical therapists, occupational therapists, dietitian coordinators, financial representatives and other subspecialists like cardiologists, psychiatrists, infectious disease specialists and pharmacists,鈥� Ganesh explains. 鈥淲e discuss the patient and decide whether they are going to be a good candidate or not. If they are a good candidate, then we list them.鈥�
The process, she emphasizes, is long. 鈥淭his is why when referring physicians ask if their patient is going to be listed soon, the answer is no. That is why we want patients referred early on so that they can make it through the testing to determine whether they are going to be good candidates.鈥�
It鈥檚 very rare, but sometimes a physician can try to refer a patient to a transplant center prematurely, Ganesh says. If this happens, the transplant center won鈥檛 list the patient 鈥� yet.
鈥淚f you鈥檙e going to transplant someone, we make sure it鈥檚 the appropriate time for that specific patient,鈥� she says. 鈥淭ransplant is a major surgery that comes with complications. We don鈥檛 just transplant everyone who is referred; we transplant those who need it most.鈥�
If a patient is referred too early, 鈥淲e鈥檒l call the referring physician back and tell them the patient is too early for a transplant,鈥� she says. 鈥淲e notify them to keep us informed about the patient鈥檚 clinical status and pulmonary function test numbers, and if the numbers start to drop further, to call us back.鈥�
Ganesh鈥檚 goal is to raise awareness among referring physicians about the optimal time to refer a patient. It鈥檚 dangerous to believe that patients must be treated maximally first and only referred for transplant when all else fails, she says.
鈥淭hat thinking process must change,鈥� she says. 鈥淒octors should not be thinking of a transplant as a very last option. Their thinking process should change to include lung transplant as another treatment modality they are providing to the patient. Lung transplants should be part and parcel of treatment planning. If a patient falls under the guidelines of needing to be referred, they can be referred while still receiving treatment such as the medications they need.鈥�
Ganesh points to one last reason why some physicians may wait until the last minute to refer: 鈥淥nce they refer, they feel like they are losing their patient to another center and that the patient won鈥檛 come back to them.鈥�
When community doctors refer patients, Ganesh says she makes a point of working collaboratively with them early on. 鈥淚 try to reassure them that after we transplant the patient, the patient will come back to them for future follow-up. We will take care of the transplant piece; they can take care of the rest of the patient.鈥�
There is still a lot of progress to be made in spreading these messages. 鈥淚n my experience, I don鈥檛 get the phone call that says, 鈥楬ey, I saw a pulmonary fibrosis patient today for the first time. These are the numbers. Can I plug this patient into a transplant center?鈥欌�� Ganesh says. 鈥淚 don鈥檛 get that call. I get the call that says, 鈥極h, the patient is intubated; there鈥檚 nowhere to go. Can you take this patient?鈥� So, I will emphasize that shift must happen. Otherwise, we are going to lose a lot of patients to these diseases without getting them a transplant.鈥�
Share
