The following guidelines were adapted from the International Society of Heart Lung Transplantation and represent general guidelines. Each patient must be individually assessed to determine if lung transplantation is the best option for treatment of their end stage lung disease. In addition, each center may have slightly varying criteria. Lung Transplantation should be considered when patients have marked limitation of ordinary physical activity due to fatigue or dyspnea but are still comfortable at rest (NYHA Class III/IV.

Indications for Lung Transplant Referral

• Chronic Obstructive Lung Disease (COPD)
• FEV1 < 25% of predicted
• Evidence of hypercapnia on arterial blood gas analysis
• Secondary pulmonary hypertension
• Recurrent life threatening exacerbations
• BODE score >6
• Idiopathic Pulmonary Fibrosis (IPF)
• Early referral preferred
• Total lung capacity < 60%
• Resting hypoxia
• Secondary pulmonary hypertension
• Clinical decline (>10% loss of FVC in 6 months)
• Cystic Fibrosis (CF)
• FEV1 < 25 % of predicted
• Resting hypercapnia
• Secondary pulmonary hypertension
• Pulmonary Hypertension
• On Maximum medical therapy
• Sarcoidosis
• Interstitial Lung Disease (non autoimmune)
• LAM

Absolute Contraindications to lung transplant

• Non-Smoking - must be “nicotine free” for at least 6 months
• Active substance abuse
• Age > 65 or < 14 years old
• History of Cancer (excluding non melanoma skin) within past 5 years
• Beliefs prohibiting blood transfusion
• Ventilator dependence defined as continuous CPAP or endotracheal intubation
• History of Burkholderia, HIV, Hepatitis C or other chronic uncontrolled infection
• Severe medical comorbidities such as:
  • Diabetes mellitus with end organ damage (nephropathy, retinopathy)
  • Impaired renal function: GFR<50
  • Severe Coronary Disease: Three vessel CAD-regardless of degree of stenosis, or 2 vessel CAD with > 50% stenosis
  • Impaired cardiac function
  • Connective Tissue Disease /Autoimmune
• Inadequate social support – minimum 2 support people
• Hx of medical noncompliance/nonadherence

Relative Contraindications

• Osteoporosis with symptomatic fractures
• Stented single CAD
• Previous chest wall surgery
• Panresistant organisms
• Chronic narcotic use
• BMI < 17; BMI > 30; minimum weight 40kg