Refer Your Patient

To refer a patient for lung transplant evaluation or to speak with a member of our staff, please call 1-855-EMORYTX (366-7989) – toll free number, Monday through Friday from 8 a.m. to 4:30 p.m.

The following items are required for a lung transplant referral to be processed:

• Completed Referral Form (PDF 100 KB)
• A dictated progress note or History & Physical which summarizes the patient’s course and care, and includes a complete list of relevant past medical history
• Recent pulmonary function testing
• Radiologic films and reports (Chest X-ray, CT of the chest, bone density studies, etc.)
• Pathology and Operative reports, where applicable
• Cardiac catheterization reports, where applicable
• Patient’s smoking history and documentation of cessation, if applicable
• Notes from any other transplant centers that have seen the patient
• Notes from any consulting physicians that have seen the patient.
• A signed consent to obtain outside medical records
• Copy of front and back of patient's insurance card

These items can be faxed to 404-727-1516. Faxed referral information will be reviewed by a transplant pulmonologist. If your patient has contraindications to transplantation, the transplant pulmonologist will contact you to discuss the patient’s case.

Eligibility Criteria
  • Age 16 to 70+ years (patients greater than age 65 are evaluated on a case-by-case basis)
  • Functionally limited (NYHA class III or IV) but still ambulatory with rehabilitation potential – patients hospitalized in ICU with critical or unstable clinical condition may become candidates once discharged home and ambulatory
  • Willingness to adhere to guidelines from health care professionals
  • Early referral is highly desirable, particularly in idiopathic pulmonary fibrosis
Indications and Contraindications for Lung Transplant

Indications for Lung Transplant

  • End-stage lung diseases without adequate response to optimal treatment
  •  Predicted two- to three-year life expectancy of less than 50%.

Absolute Contraindications for Lung Transplant

  • Ventilator dependence   
  • Recent malignancy (other than nonmelanoma skin cancer) in the past two to five years
  • Significant extrapulmonary vital organ dysfunction (irreversible hepatic, renal, cardiac dysfunction, bone marrow failure)
  • Severe coronary disease not amenable to intervention; severe peripheral vascular disease
  • Noncurable chronic extrapulmonary infection including chronic active viral hepatitis B, hepatitis C or HIV
  • Active infection with mycobacteria, B. cenocepacia (genomovar III) and B. gladioli
  • Substance addiction (e.g., alcohol, tobacco, narcotics) – active or within the last six months
  • Severe psychiatric illness
  • Inability to cooperate or comply with medical therapy
  • Lack of adequate social support
  • Obesity (BMI > 30) or underweight (BMI < 17) is relative contraindication
Disease Specific Guidelines

Referral for lung transplantation is recommended by international guidelines if patients meet any of the following criteria (The Journal of Heart and Lung Transplantation 2006, 25:745-755).

COPD

• BODE index exceeding five
• Deterioration despite optimal medical and surgical therapy
• History of hospitalization for exacerbation associated with acute hypercapnia (PCO2 exceeding 50 mm Hg)
• Pulmonary hypertension or Cor pulmonale or both, despite oxygen therapy

IPF

• Histologic or radiographic evidence of UIP irrespective of vital capacity
• Histologic evidence of fibrotic NSIP

CF

• FEV1 below 30% predicted or a rapid decline in FEV1 – in particular in young female patients
• Exacerbation of pulmonary disease requiring ICU stay
• Increasing frequency of exacerbations requiring antibiotic therapy
• Refractory and/or recurrent pneumothorax
• Recurrent hemoptysis not controlled by embolization

IPAH

• NYHA functional class III or IV, irrespective of ongoing therapy
• Rapidly progressive disease

Sarcoidosis, LAM, Eosinophilic Granuloma

• NYHA functional class III or IV

Emory Transplant Center