People who have a life-threatening lung disease that no longer responds to conventional treatments may be a candidate for lung transplantation. This surgery has been performed since the early 1980s, but not everyone is a candidate for this lengthy and risky procedure. What are the criteria for lung transplant?
Criteria for Lung Transplant: Why It’s Necessary to Have Criteria
Generally, lung transplant surgery is reserved for people who have end-stage lung disease, and who no longer respond to any of the available treatments. Candidates for lung transplant are carefully selected since the number of lungs available for transplantation are far fewer than the number of people who need them. In addition, it’s important to choose candidates who have the best chance of survival after the surgery.
International guidelines have been established to help physicians through the process of selecting appropriate candidates for lung transplant. The guidelines are not “set in stone”, and there may be exceptions to these guidelines based on specific circumstances and situations.
What are the Criteria?
Some candidates with end-stage lung disease aren’t good candidates for transplant because they have other serious medical problems. Any medical condition a potential candidate has should be stable and adequately treated so that it doesn’t impact survival after a lung transplant.
There are some types of medical conditions that may preclude a person from getting a lung transplant. This includes any disease that seriously impacts the function of other organs such as the kidneys or heart, but, in some cases, people with failure of more than one organ may be a candidate for a multi-organ transplant.
People with a malignancy that required treatment may not be candidates until two years have passed after treatment, and anyone treated for an advanced cancer usually requires a five year waiting period to ensure that the cancer doesn’t return or spread to other areas.
People with certain infectious diseases like hepatitis B or hepatitis C that actively involves the liver may also be excluded. People with well-controlled diabetes, other endocrine problems and connective tissue diseases are still candidates if they’re adequately treated.
The type of lung condition a patient has may also determine whether or not they meet the criteria for lung transplant. People who have lung conditions such as severe pulmonary hypertension, which affects the blood vessels that connect with the lung may not be good candidates.
Other Conditions That May Exclude a Person
People who have severe disease involving the bones, nerves or muscles, including advanced osteoporosis, may be excluded, although they may still be eligible if these diseases are adequately treated. Persons who are grossly obese or extremely underweight and malnourished may not be candidates until their weight issues are corrected since nutrition could play a role in whether they survive longer term.
People who have severe psychiatric illnesses or who have demonstrated an unwillingness to be compliant with medical treatments are usually not good candidates for lung transplant.
What about age? Lung transplants aren’t reserved only for the young. People in their sixties have successfully undergone lung transplants, and age is considered on a case-by-case basis.
The Bottom Line?
The criteria for lung transplant are well-established, but each case is considered individually, and there may be exceptions to the guidelines. The ultimate goal? To give people who will benefit the most from lung transplant surgery the opportunity to breathe easily again.
American Journal of Respiratory and Critical Care Medicine. Volume 158, No. 1. July 1998. pages 335-339.
Mayo Clinic. “Lung Transplant”