Professional Statements and Societal Positions Guidelines
The International Society for Heart and Lung Transplantation-2021
The International Society for Heart and Lung Transplantation updated its consensus-based guidelines on the selection of lung transplant recipients.
These guidelines made the following statements about lung transplantation:
Lung transplantation should be considered for adults with chronic, end-stage lung disease who meet all the following general criteria:
- High (greater than 50 percent) risk of death from lung disease within two (2) years if lung transplantation is not performed.
- High (greater than 80 percent) likelihood of five (5)-year post-transplant survival from a general medical perspective provided that there is adequate graft function.
Prior to determining that a patient is not a candidate for lung transplantation, referring providers should communicate directly with at least one lung transplant program with experience withthe candidate's potential contraindication(s).
Early referral is recommended to facilitate transplant education for the individual and caregivers, an initial assessment of barriers to transplant, and determination of timing for full evaluation with specific recommendations for optimization of candidacy.
Determination of candidacy requires a detailed evaluation not only to select appropriate candidates, but also to optimize each individual's status to provide them with the best chance for a successful outcome.
Individual transplant candidacy at a particular institution depends on that center's expertise for management of individuals who have risk factors posing high or substantially increased risk.
Decision making regarding timing of listing for transplant should take into consideration results of the full evaluation, including disease severity and trajectory, estimated wait time for donor organ(s) and survival time without transplant, and candidate's readiness for transplant.
Just as the decision to list is carefully considered, interval reassessment for continued listing should take place to evaluate the risks and benefits of transplant when considering any changes to the candidate's status that may impact predicted perioperative or post-transplant outcomes.
When referring for lung transplant evaluation, consider simultaneous referral to palliative care to provide decision support and treatment selection that is consistent with goals of care throughout the transplant evaluation, listing, surgery, and posttransplant.
For combined heart/lung transplant, the guidelines have stated that:
Heart-lung and other multi-organ transplantation should be limited to centers with experience in such procedures and where specialists are available to manage each of the transplanted organs.
Candidates should meet the criteria for lung transplant listing and have significant dysfunction of one or more additional organs, or meet the listing criteria for a non-pulmonary organ transplant and have significant pulmonary dysfunction.
Waiting times are likely to be longer and the likelihood of receiving a transplant is reduced when an individual requires more than one organ. Thus, referral should occur earlier in the disease course if multi-organ transplantation may be considered.
