When to refer a patient for lung transplantation

Lung transplantation has become a therapeutic option for selected patients with end-stage pulmonary parenchymal or vascular disease. This is primarily because survival has increased to 60% locally (Figure 1) and internationally at 2 years after lung transplantation [1, 2]. When heart and lung transplantation was the only procedure to treat such patients and waiting times were <6 months, the principle criteria to determine transplant candidacy was the presence of right ventricular failure. Because isolated lung transplantation has replaced heart and lung transplantation and the average waiting time for a donor has increased to 18–24 months, criteria requiring right heart failure for transplant candidacy are no longer viable. Thus the appropriate time to refer, list and perform a lung transplant is unclear.