Lung Transplant Evaluation
Step One: Am I Eligible?
For More InformationA lung transplant evaluation helps your doctors decide if transplantation is the best therapy to improve your condition and to determine if you have any health concerns that would affect your recovery. The evaluation includes consultations with transplant team members, physical examinations, blood work, and other tests. We gather a great deal of information so we can make recommendations as quickly as possible about your ability to have a successful transplant.
Reasons for Lung Transplantation
Lung transplantation can be an option for people with end-stage lung disease -- when your lungs are so unhealthy that they cannot function, and your lung disease cannot be corrected any other way. The following lung diseases may cause your lungs to fail:
- Pulmonary fibrosis
- Chronic obstructive pulmonary disease (COPD)
- Cystic fibrosis
- Pulmonary hypertension
- Scleroderma
- Sarcoidosis
- Alpha-1 antitrypsin deficiency
- Occupational lung disease
- Lung disease due to prior cancer treatments, such as bone marrow transplant, radiation, and chemotherapy
Lung transplant surgery is performed at Duke University Hospital. Pre- and post-transplant appointments take place at our pulmonology clinic in Durham.
Lung Transplant Evaluation Tests
Evaluation for lung transplantation can occur in the hospital or as an outpatient. You may have a two-day (limited) evaluation or a full, five-day evaluation. The schedule depends on how healthy you are, the timing of your transplant, and if you are able to tolerate activity. You will have some or all of the following tests, plus additional testing as needed.
Blood Tests
Several blood tests will be performed to determine your blood type and assess the health of your kidneys, liver, and immune system. We also check for viruses or other infections that could cause a problem after surgery.
Pulmonary Function Tests
These tests measure your breathing capacity. You will be asked to breathe in and out while a technologist measures the amount of air and the strength of your lungs.
If you are interested in making an appointment for an evaluation, please ask your pulmonologist to submit a referral.
Imaging
A series of imaging scans will give your doctor detailed pictures of your organs, blood vessels, and other vital structures. All of these scans are noninvasive and painless.
- An echocardiogram evaluates your heart’s valves. It also measures your heart’s ability to pump blood throughout the body.
- A ventilation-perfusion (V/Q) scan measures blood and air supply to your lungs and looks for blood clots in the lungs.
- A chest CT scan provides a 3D image of the inside of your lungs and chest.
Arterial Blood Gas Analysis
This blood test measures how efficiently your lungs bring oxygen into the blood and remove carbon dioxide.
Heart Catheterization
In this minimally invasive procedure, your doctor will numb an area of your skin and insert a small tube (called a catheter) into an artery in your groin. The catheter will be guided into your heart to take detailed assessments of the pressures and blood flow inside your heart and lungs.
Our doctors are leaders in transplantation research, which gives you access to best practices and new therapies through our lung transplant programs and clinical research.
Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our pulmonology and lung surgery program is nationally ranked, and the highest ranked program in North Carolina, according to U.S. News & World Report for 2021–2022.
Next Steps
After the evaluation is complete, the entire lung transplant committee meets to discuss your results and determines whether a lung transplant should be your next step. We perform both single- and double-lung transplants, as well as heart-lung transplants, depending on factors such as your underlying disease and previous chest surgeries. Your committee may decide:
- Lung transplantation is not the best treatment option. This may be because of an ongoing health condition like cancer or a lifestyle choice such as smoking.
- It is too soon for transplant. In this case, the team will continue to monitor your health to identify the best time for transplantation in the future. Being evaluated early in your transplant journey is recommended; this gives you time to prepare physically, mentally, and financially for surgery.
- More information is needed. If this is the committee’s decision, you will be asked to complete additional tests or meet certain goals -- like losing weight -- to improve your candidacy.
- Lung transplantation is the best treatment option for you. After completing pulmonary rehabilitation and meeting other requirements, you will be approved for listing on the national United Network of Organ Sharing (UNOS) lung transplant waiting list.