Lung Transplant Evaluation

Step Two: Testing and Health Commitments

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Lung transplant evaluations include 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. We may recommend a complete, five-day in-person evaluation or a two-day limited evaluation. Video-based appointments are offered for limited evaluations in many states. 

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Two Options for Lung Transplant Evaluation

We recommend a limited evaluation or a complete evaluation based on how healthy you are, the timing of your transplant, and if you are able to tolerate activity.

Two-Day Limited Evaluation
This option is for people with less advanced lung disease who have time to wait before transplant. It requires some testing, which can be performed at your local health facility or at Duke. These appointments can take place remotely via telehealth or in person.  

Five-Day Complete Evaluation
Complete evaluations are required before you can be added to the national waitlist for a donor organ. They are reserved for people with advanced lung disease who are ready for surgery and involve more extensive testing than the two-day option.

Our Locations

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.

Ready for an Evaluation?

If you are interested in making an appointment for an evaluation, please ask your pulmonologist to submit a referral.


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.

Best Hospital for Pulmonology and Lung Surgery in NC

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 2023–2024.

Esophageal Manometry Test

This procedure shows your doctor how the muscles in your esophagus work when you swallow. A catheter is passed into your stomach through your nose. During the test, you will be asked to swallow water.

24-Hour Gastric pH Test

This test is usually performed right after the esophageal manometry test. It determines how often acid from your stomach comes up into your esophagus. A small tube is placed in your stomach through your nose and will stay in place overnight. You will be asked to keep a food and drink diary while the test is in progress. The next morning, the tube will be removed.

Pulmonary Physical Therapy Assessment

This exercise evaluation involves a six-minute walk test. It determines your tolerance for physical activity and your oxygen needs for activity.

Clinical Trials at Duke

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.

Requirements for Lung Transplant Consideration

To be considered for a lung transplant, you must commit to staying healthy. The healthier you are, the better your odds are for a successful surgery.

Stop Smoking

We require that you abstain from nicotine in all forms, including cigarettes, patches, and gum for six months before surgery. You must also complete a relapse prevention program and remain completely nicotine-free after transplant. Blood tests that reveal any exposure to tobacco will be performed at each transplant clinic visit. Our smoking cessation programs offer personalized treatment plans to help you quit for good. 

Participate in Pulmonary Physical Therapy

We require participation in our pulmonary rehabilitation program before your transplant to ensure physical readiness for surgery. You will spend several weeks taking part in supervised exercise -- at least three days a week -- and transplant education classes led by our lung transplant team. If you live more than two hours from Duke, we can help you relocate to Durham so that you can participate in the program.

Choose a Caregiver

When you have a lung transplant at Duke, you are required to choose a primary caregiver who will support you throughout the transplantation process. They will:

  • Attend appointments and education sessions
  • Drive you to and from appointments, physical therapy, and surgery
  • Manage your medications after surgery
  • Provide personal care support (bathing, cooking, and chores)

Follow Recommendations from Your Transplant Team

You may be asked to adhere to a special diet, gain or lose weight, and meet other requirements such as taking medications as prescribed and attending all appointments with your transplant team.

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.


Step 3: Waiting for Lungs

This page was medically reviewed on 12/05/2022 by