After your week of lung evaluations, your evaluation results are presented to a multidisciplinary transplant-selection committee that determines which patients are eligible for transplantation.

Committee members include the transplant professionals you met during the evaluation. They review the results of your physical studies and discuss your understanding of your illness, the transplant process, and how lung transplantation will affect you and your family.

Selection Criteria

The committee uses selection criteria to determine if patients are appropriate candidates for the lung transplant waiting list. In order to be considered, patients must:

• Have a chronic, end-stage lung disease that is failing to respond to maximal medical therapy or for which no effective medical therapy exists
• Have limited life expectancy with continued maximal medical therapy
• Participate in pulmonary rehabilitation
• Have a consistent and reliable social support system
• Be able to get to Duke University Hospital within two hours of an organ being available
• Abstain from nicotine-containing substances for at least six months prior to transplant
• Be able to relocate to the Durham, NC, area to attend at least 23 sessions of post-transplant pulmonary rehabilitation
• Be able to meet the financial obligations of transplantation, medication costs, supportive therapies, and relocation expenses

Exclusion Criteria

The following exclusion criteria prevent patients from being candidates for lung transplantation:

• Malignancy in the last two years, with the possible exception of localized malignancies such as certain types of limited lung cancer, cutaneous squamous-cell cancers, and basal-cell carcinomas
• Untreatable advanced dysfunction of another major organ system (such as heart, liver, or kidney) unless the patient is a candidate for multi-organ transplant
• Non-curable chronic extrapulmonary infection including chronic active viral hepatitis B, hepatitis C, and human immunodeficiency virus (HIV)
• Significant chest-wall and/or spinal deformity
• Excessive obesity or malnourished state, which are generally defined as greater than 130 percent of ideal body weight (IBW) or less than 70 percent IBW, respectively
• Untreatable psychiatric or psychological condition associated with the inability to cooperate or comply with medical therapy
• Documented non-adherence to medical therapies and appointments
• Addiction to substances such as alcohol, tobacco, or narcotics that is either active or has occurred within the previous six months
• Severely limited functional status with poor rehabilitation potential
• Severe and/or symptomatic osteoporosis
• Chronic, active use of narcotics or benzodiazepines
• Severe esophageal dysmotility

Heart-Lung Transplantation

The selection criteria above also apply for combined heart-lung transplant referrals. In addition, patients must have significant cardiac dysfunction that excludes isolated lung transplantation. Patients must be younger than 60 years old for consideration.

Selection Committee Recommendations

There are three possible outcomes that can be made by the committee after your evaluation:

• You will not be listed as a lung-transplant candidate
• Our team will reconsider your evaluation after you undergo additional studies and/or meet certain individual goals
• You are approved for listing on the national lung-transplant waiting list

The transplant coordinator will contact you to tell you about the team's decision. You will also receive a letter with the outcome of your evaluation within 10 days of the selection conference.