Answer

A candidate for a lung transplant typically has a severe, end-stage lung disease that hasn’t responded to other treatments and is expected to lead to death within 1-2 years. Specific conditions that may qualify someone for a lung transplant include:

Obstructive Lung Diseases:

• Chronic Obstructive Pulmonary Disease (COPD): Severe COPD, especially when combined with emphysema, can make patients eligible. This includes those with Alpha-1 antitrypsin deficiency-related emphysema.
• Cystic Fibrosis: Lung transplantation is a common and effective treatment option for individuals with advanced cystic fibrosis and declining lung function, who have significant infections or antibiotic resistance.
• Bronchiectasis: Severe bronchiectasis unresponsive to medical and surgical interventions may be an indication for transplant.

Restrictive Lung Diseases:

• Idiopathic Pulmonary Fibrosis (IPF): This is a progressive scarring of the lungs with no known cause. It’s one of the most common reasons for lung transplant.
• Sarcoidosis: Advanced sarcoidosis with significant lung involvement can be a transplant indication, particularly if other organs are not severely involved.
• Other Interstitial Lung Diseases (ILDs): Conditions like hypersensitivity pneumonitis, connective tissue disease-related ILD (e.g., rheumatoid arthritis, scleroderma, lupus), and pneumoconiosis can be considered.
• Lymphangioleiomyomatosis (LAM): A rare lung disease that primarily affects women.

Pulmonary Vascular Diseases:

• Pulmonary Hypertension (PH): Particularly idiopathic pulmonary arterial hypertension (IPAH) or pulmonary hypertension associated with other conditions (e.g., connective tissue disease, congenital heart disease).
• Chronic Thromboembolic Pulmonary Hypertension (CTEPH): Though often treated with pulmonary thromboendarterectomy (PTE), lung transplant might be an option if PTE is not possible or unsuccessful.

Other Conditions:

• Alpha-1 Antitrypsin Deficiency: Genetic disorder that can lead to emphysema.
• Rejection of a Previous Lung Transplant: In some cases, a second lung transplant may be considered.
• Eisenmenger Syndrome: Advanced cases with significant lung involvement.

General Selection Criteria:

Beyond the specific diagnosis, transplant centers have other strict criteria to determine eligibility, including:

• Severity of Lung Disease: This is usually assessed using pulmonary function tests (FEV1, DLCO), arterial blood gases, exercise capacity (6-minute walk test), and other measures. Candidates usually have an FEV1 (forced expiratory volume in one second) less than 25-30% predicted or are rapidly declining, experience significant hypoxemia or hypercapnia, or have severely impaired exercise tolerance.
• Age: Generally, candidates are under 65-70 years old (but age cutoffs can vary between centers). The overall health and functional status of older individuals are particularly important.
• Overall Health: Candidates must be in relatively good health otherwise. Significant heart, kidney, or liver disease can be contraindications.
• Nutritional Status: Malnutrition is common in end-stage lung disease. Candidates need to be able to maintain adequate nutrition.
• Psychological Stability: Candidates need to be psychologically stable and able to adhere to the complex post-transplant medication and follow-up regimen.
• Social Support: A strong social support system is crucial for recovery and long-term success.
• Commitment to Treatment: Candidates must be committed to the intensive post-transplant care, including medication adherence, pulmonary rehabilitation, and regular follow-up appointments.
• Absence of Active Infection: Active infections, especially those resistant to antibiotics, need to be treated before transplant.
• Cancer-Free Status: Candidates should be free of active cancer for a significant period (usually 2-5 years, depending on the cancer type).
• Absence of Substance Abuse: Active smoking, alcohol abuse, or drug abuse are typically absolute contraindications.
• Body Mass Index (BMI): Extremely high or low BMI can negatively affect outcomes.
• Absence of other Systemic Diseases: Some systemic diseases may affect eligibility, such as amyloidosis or uncontrolled diabetes.

Absolute Contraindications:

Certain conditions may make a person ineligible for lung transplantation, including:

• Active, uncontrolled malignancy.
• Active, untreatable systemic infection.
• Significant dysfunction of other major organs (heart, liver, kidneys) that is not reversible.
• Severe chest wall deformity that would make transplant technically impossible.
• Untreatable psychiatric illness that would preclude adherence to the post-transplant regimen.
• Active substance abuse.
• Lack of adequate social support.
• Some centers consider colonization with highly resistant bacteria (e.g., Burkholderia cepacia complex) in cystic fibrosis to be an absolute contraindication.

Evaluation Process:

The evaluation process for lung transplant is comprehensive and involves:

• Medical History and Physical Examination: Detailed assessment of the patient’s overall health.
• Pulmonary Function Tests: Measurement of lung volumes, airflow, and gas exchange.
• Arterial Blood Gases: Assessment of oxygen and carbon dioxide levels in the blood.
• Imaging Studies: Chest X-rays, CT scans, and possibly MRI to evaluate the lungs and other organs.
• Cardiac Evaluation: Electrocardiogram (ECG), echocardiogram, and possibly cardiac catheterization to assess heart function.
• Blood Tests: Comprehensive blood work to assess organ function, immune status, and infection.
• Infectious Disease Screening: Testing for HIV, hepatitis, and other infections.
• Cancer Screening: Age-appropriate cancer screening tests.
• Nutritional Assessment: Evaluation of nutritional status and counseling.
• Psychological Evaluation: Assessment of psychological health and coping skills.
• Social Work Evaluation: Assessment of social support and resources.
• Exercise Testing: Six-minute walk test or cardiopulmonary exercise testing to assess exercise capacity.
• Bronchoscopy: Examination of the airways with a flexible scope, sometimes with biopsies.

The transplant team, including pulmonologists, surgeons, nurses, social workers, and other specialists, reviews all the information to determine if the patient is a suitable candidate for lung transplantation. Being listed does not guarantee a transplant will occur.