1. 11/11/16 Kirstie Wallace/Hazel Muse Transplant Co-ordinators
5/1/2018
Lung Transplant Assessment
11/11/16
Kirstie Wallace/Hazel Muse
Transplant Co-ordinators

2. Referring zones Northern region Northern Ireland Scotland - Lungs
Eire - paediatrics only
Adult congenital patients
Paediatric patients
Patient/Physician choice

4. Referral pathway
Referral proforma
Turn down
Satellite clinic
Inpatient assessment
In-patient assessment
Further investigation and review
Too good
Active list

5. Transplant Assessment
Four day in-patient assessment
Patient asked to bring carer
Two way process for sharing information
Medical assessment, and an opportunity for second or third opinion
Patient learns outcome of assessment

6. Lung Transplant Assessment
Is the patient sick enough?
Full lung function including transfer factor
ABG’s
6 MWT
Perfusion scan
CT scan - current
Disease progression
Microbiology

7. Aims of assessment
To identify appropriate recipients and list them at the optimum time
An opportunity to educate the patient and their family about their condition and future treatment options

8. Points of discussion Does the patient understand their condition?
Does the patient understand the reason for referral?
Does the patient understand their disease prognosis?

9. Transplant Assessment
Four questions to answer
1. Does the patient require a transplant ?
2. Is the patient physiologically/physically strong enough to survive a transplant ?
3. Which operation and when? What degree of risk?
4. Does the patient want a transplant ?
(informed consent)

10. Absolute contra -indications
Other end organ failure
Malignancy within 5yrs (usually)
Active systemic infection
Drug, alcohol, nicotine dependence

11. Relative contra-indications
Other organ dysfunction
Maintenance steroid > 20mg/day
Osteoporosis with fracture history
High/low BMI <17 or >30
Non compliance, non concordance
Multiple antibiotic allergies
Very resistant microbiology
Surgical issues
Frailty Index?

12. Transplant Team Patient Medical staff Nursing staff Social worker
Co-ordinator
Physiotherapist
Clergy
Dietician
Psychology

13. 5/1/2018
5/1/2018 13

14. Is the patient fit enough?
Cardiac function
Liver function/ Renal function
BMI
Other co-morbidities – diabetes, osteoporosis, GORD
General physical condition – frailty index?
Surgical issues – anatomy, previous surgery
Micro issues - sensitivities/allergies, cocktail

15. What does the patient want?
Education
Informed consent
Risk/benefit
Donor decisions

17. Window of opportunity
Wellbeing
COPD CF
IPF
Time

18. Outcome of assessment Not for transplant
Too good for transplant (at present)
Needs further investigation/management
Accept for transplant

19. Accepted for active list
Which operation?
Heart lung
Bilateral lung
Single lung (which side?)
Accepted for active list

20. Managing the waiting list

21. Active list considerations
Organ waiting times are not predictable
Organs are matched to recipient using blood group and size, usually related to recipient total lung capacity (TLC)
HLA antibodies
Unfortunately % of patients die before a transplant is possible

22. Challenges Working within limitations of resources
Waiting times for clinic and in patient admission
Managing patient/carer expectations
Managing referring centres expectations
Maintaining objectivity
Managing waiting list
Accepting we cannot save everyone

23. Alternative techniques
Lobar transplant
EVLP
Novalung
ECMO

24. References
International society of Heart Lung Transplantation Annual Reports 2012, 2013
Selection of Candidates for Lung Transplantation Kreider and Kotloff Proc Am Thorac Soc vol 6 pp 20-27, 2009
Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates – J Heart Lung Transplant 2006;25:
Indication, patient selection and timing of referral for lung transplantation. Verlden , Fisher Eur Respir Mon 2009
NHSBT Activity report
Frailty: What does it mean for Clinical Care Provision? – Scottish Universities Medical Journal 2014 Vol3 (Issue1)