University of Virginia Health System

Lung Transplantation

Referral and Evaluation

The process of care for lung transplantation is a journey of five parts: the referral, the evaluation, the listing and wait period, the transplant procedure, and post-transplant care.

Referral for Transplantation

The process of transplant evaluation begins with a referral to the transplant program. A family doctor or pulmonologist may make a referral or the patient may initiate the process by contacting our referral coordinator (at 800-257-0757). The coordinator will begin to collect basic information and will contact a financial counsellor in order to begin to assess and provide advice on basic financial questions and initiate contact with any relevant insurers.

Who Needs a Lung Transplant? 

A lung transplant might be needed when a patient has end stage lung disease (that is, when disease stops lungs from working properly).  The UVa Lung Transplant Program believes that all other medical therapies should be considered before transplantation. The following diseases can lead to a need for lung transplant:

• Chronic obstructive pulmonary disease (COPD -- which often includes chronic bronchitis, emphysema, and/or Alpha 1 antitrypsin deficiency).
• Sarcoidosis
• Eosinophilic granuloma
• Bronchiectasis
• Cystic fibrosis
• Pulmonary hypertension (primary or secondary)
• Lymphangiomyomatosis (LAM)
• Pulmonary Fibrosis

Patients with the following problems will, generally, not qualify for a lung transplant:

• Severe debilitation or ventilator dependence
• Severe renal, liver or cardiac disease
• Active tobacco use (including smoking, chewing, snuff, etc.)
• Active alcohol or drug abuse (last 6 months)
• Inability to follow a complicated medical regimen
• HIV/AIDS
• Active hepatitis infection
• Active cancer
• Obesity (Body Mass Index (BMI) > 30)

The Evaluation

Patients referred to the lung transplant program go through an evaluation to assess their need for transplant and their ability to benefit from the surgery. This will involve several visits to the University of Virginia Health System, usually conducted on an outpatient basis. This process begins with a review of insurance coverage and the financial challenges associated with transplantation.

Tests most commonly performed include:

• lung function tests,
• a six-minute exercise test,
• blood work,
• chest x-ray,
• ventilation/perfusion scan,
• chest CAT scan,
• echocardiogram,
• ECG,
• abdominal ultrasound,
• bone density scan,
• cardiac catheterization, and
• neuropsychological testing.

In most cases, medical testing will take four days and the entire process may take some weeks.

A psychosocial evaluation will also be completed, covering medical and social history, insurance coverage, financial resources and family/friend support system. A reliable support system is a necessity throughout the transplant process for emotional encouragement, help with transportation to appointments and assistance during the recovery period. 

In addition, you'll meet with a neuropsychologist who will see how well you can learn and remember new information to see if you will need any extra help in remembering complex medical information. The neuropsychologist will also talk with you about your emotions and how you are coping with the stress of your medical condition.

For further details regarding patient referral, please contact the Lung Transplant office at (800) 257-0757.