Transplant Waiting List

Since January 1988-May 2011, there have been 22,279 lung transplants performed in the US.

• In 2011, 1,770 lung transplants were performed nationwide.
• There are currently over 1,700 people awaiting a lung transplant.

Where do transplanted organs come from?

The majority of lungs that are transplanted come from deceased organ donors. Organ donors are adults or children who have become critically ill and will not live as a result of their illness. If the donor is an adult, he/she may have agreed to be an organ donor before becoming ill. Parents or spouses can also agree to donate a relative's organs. Donors can come from any part of the United States. This type of transplant is called a cadaveric transplant.

• California Transplant Donor Network

How are transplanted organs allocated?

The United Network for Organ Sharing (UNOS) is responsible for transplant organ distribution in the United States. UNOS oversees the allocation of many different types of transplants, including liver, kidney, pancreas, heart, lung, and cornea.

UNOS receives data from hospitals and medical centers throughout the country regarding adults and children who need organ transplants. The medical team that currently follows a patient is responsible for sending the data to UNOS, and updating them as a patient's condition changes.

Once UNOS receives the data from local hospitals, people waiting for a lung transplant are placed on a waiting list and given a "status" code.

When a donor lung becomes available, a computer searches all the people on the waiting list for a lung and sets aside those who are not good matches for the available lung. A new list is made from the remaining candidates.

The person at the top of the specialized list is considered for the transplant. If he/she is not a good candidate, for whatever reason, the next person is considered, and so forth. Some reasons that people lower on the list might be considered before a person at the top include the size of the donor organ and the geographic distance between the donor and the recipient.

How is a patient placed on the waiting list for a new lung?

An extensive evaluation must be completed before a patient can be placed on the transplant list. Testing includes:

• blood tests
• diagnostic tests
• psychological and social evaluation of the patient and the family

Tests are done to gather information that will help ensure a patient receives a donor organ that is a good match. These tests include those to analyze the general health of the body, including the patient's heart, lung, and kidney function, the patient's nutritional status, and the presence of infection.

Blood tests will help improve the chances that the donor organ will not be rejected. These tests may include:

• patient's blood type: Each person has a specific blood type: type A+, A-, B+, B-, AB+, AB-, O+, or O-. When receiving a transfusion, the blood received must be a compatible type with the patient's own, or an allergic reaction will occur. The same allergic reaction will occur if the blood contained within a donor organ enters the patient's body during a transplant. Allergic reactions can be avoided by matching the blood types of the recipient and the donor.
• kidney, liver, and other vital organ function tests
• viral studies: These tests determine if the patient has antibodies to viruses that may increase the likelihood of rejecting the donor organ, such as cytomegalovirus (CMV).

The diagnostic tests that are performed are extensive, but necessary to understand the complete medical status of the patient. The following are some of the other tests that may be performed, although many of the tests are decided on an individual basis:

• blood tests
• urine tests
• echocardiogram - a procedure that evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor that produce a moving picture of the heart and heart valves.
• electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
• cardiac catheterization - a diagnostic procedure in which a tiny, hollow tube (catheter) is guided through a vein or artery into the heart in order to image the heart and blood vessels. An iodine compound (a colorless, liquid dye) is given through the catheter and moving x-ray pictures are made as the dye travels through the heart.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• lung biopsy - a procedure in which tissue samples are removed (with a needle or during surgery) from a lung for examination under a microscope.
• MUGA heart imaging - a nuclear scan to see how the heart walls move and how much blood is expelled with each heartbeat.
• sputum culture - a diagnostic test performed on the material that is coughed up from the lungs and into the mouth. A sputum culture is often performed to determine if an infection is present.
• pulmonary function tests - diagnostic tests that help to measure the lungs' ability to exchange oxygen and carbon dioxide appropriately. The tests are usually performed with special machines that a patient must breathe into.
• tuberculosis (TB) test
• chest computed tomography scan of the lungs (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

The transplant team will consider all information from interviews, the patient's medical history, physical examination, and diagnostic tests in determining whether the patient is a candidate for lung transplantation. After the evaluation and after the patient has been accepted to have a lung transplant, the patient will be placed on the United Network for Organ Sharing (UNOS) list.

How long will it take to get a new lung?

There is no definite answer to this question. It may take one to two years on the waiting list before a suitable donor lung is available. It may happen in as little as 3 months or up to two years before a suitable donor is available. Various support groups are also available to assist you during this waiting time.

How are we notified when a lung is available?

Each transplant team has their own specific guidelines regarding waiting on the transplant list and being notified when a donor organ is available. In most instances, you will be notified by phone or pager that an organ is available. Patients will be told to come to the hospital immediately so he or she can be prepared for the transplant.