Who is a candidate for lung transplantation?
People needing a lung transplant have lung problems that are getting worse despite medical treatment. Some of the diseases that are treated with lung transplantation are:
Emphysema/COPD (chronic obstructive pulmonary disease)
Idiopathic pulmonary fibrosis
Primary pulmonary hypertension
Alpha-1 antitrypsin deficiency
Will my insurance cover my transplant? How much?
UW Health has contracts with many insurance providers, Medicare and Wisconsin Medicaid. You need to contact your insurance company to find out your coverage for the costs of your transplant surgery and the necessary post-transplant medication. After contacting your insurance company, if you still have questions, you may ask for one of our transplant financial counselors to assist you.
How does your system work once I am referred?
You first speak to a lung transplant coordinator who obtains information about your medical condition and your medical records. This information is presented to the lung transplant team, which determines whether you are a candidate for a lung transplant consult. If so, a visit will be scheduled for you to discuss transplantation as a treatment option.
It is important for you to bring a support person with you on this visit. The process will be explained to you at this time and your questions answered. When going through the transplantation process, a coordinator is assigned to you who will assist you throughout the entire process.
Will I have to move closer to Madison before transplant? When?
The UW Hospital and Clinics lung transplant program does not generally require you to relocate to Madison to wait for your transplant. We will work with you to set up transportation for when a donor is identified that will get you to the hospital within four hours. This may include ambulance or air transportation. Occasionally, a patient is asked to relocate to the Madison area when the travel to the hospital could be life threatening. If this should occur, the lung transplant team will inform you when you need to move to the area.
How long do I have to wait before transplant? How sick do I have to be before I get transplanted?
The number of patients on the waiting list in North America for lung transplantation is 1,625 and approximately 1,700 lung transplantations occur every year. Because of the shortage of organs, the waiting list is growing faster than the number of organs available. The allocation of organs is determined by the United Network of Organ Sharing (UNOS) as disclosed below. Because of the shortage of organs, you may have to wait two years or longer for a new lung, depending upon your severity level.
Will I get a single or a double lung transplant?
This will be dependent upon your medical condition. The type of transplant you need will be discussed during your evaluation.
How long will I be in the hospital?
You can expect to be hospitalized for approximately 14 days.
How long do I have to stay in the Madison area?
You will need to stay close by the hospital for an additional one to two weeks following surgery to transition you and help you become comfortable with your medications and daily care. Our housing coordinator can help you with housing arrangements.
How is the lung allocation determined?
The lung allocation system was developed by UNOS to ensure that lungs are offered to the candidates who are most urgently in need of a transplant and who are expected to receive the greatest benefit. The lung allocation system uses a formula that estimates each candidate's medical urgency prior to transplant and their probability of prolonged survival following a transplant. Lungs are allocated based on a lung allocation score (LAS), blood type, age, and geographic location between the recipient and donor. The only time that a patient's wait time on the transplant list is factored into the allocation system is when there may be a tie between two candidates, which would be highly unusual.
What is the lung allocation score?
The lung allocation score (LAS) is used to rank potential recipients 12 years of age and older. The LAS measures the medical urgency and life expectancy of a listed patient for lung transplant. Medical information specific to each lung transplant candidate, such as lab values, test results and disease diagnosis, is input into the UNOS database, which then calculates a lung allocation score from 0 to 100 for each transplant candidate. The medical information used to calculate the lung allocation scores consists of:
Forced vital capacity: This is a lung function test that measures the maximum amount of air you can breathe out after you breathe in as deeply as possible. This amount may be lower in patients with lung disease.
Pulmonary artery pressure: This is the pressure the heart must generate to pump blood through the lungs. This pressure may be high in some people with serious lung disease.
Oxygen at rest: This is the amount of oxygen needed at rest to maintain adequate oxygen levels in the blood. People with severe lung disease may need additional oxygen.
Age: This is the candidate's age at the time lungs are offered.
Body Mass Index (BMI): BMI is a ratio of a person's weight to height that, when interpreted with other medical test results, helps to evaluate health status.
Diabetes: Diabetes may be a predictor of health status in some people with lung disease.
Functional status: The New York Heart Association classifications measure effects that lung disease may have on a person's function in everyday life.
Six-minute walk distance: In the six-minute walk test, transplant candidates are asked to walk as far as they can in six minutes. The distance walked is a measure of functional status.
Assisted ventilation: The use of a ventilator to assist breathing may be a measure of disease severity and may affect success after a transplant.
Pulmonary Capillary Wedge Pressure (PCW): PCW or "wedge pressure" is the pressure that blood returning to the heart from the lungs must overcome. This pressure can become increased when the heart is not pumping effectively.
Serum creatinine: Serum creatinine levels are a measure of kidney function. High creatinine levels reflect impaired kidney function, sometimes associated with severe lung disease.
Diagnosis: Research has shown that urgency among people needing a lung transplant and success following a lung transplant vary among people with different lung diseases. Therefore, for every lung transplant candidate, diagnosis factors into the calculation of the lung allocation score.
Additional information on the lung allocation system is available at the following Web sites: