As soon as your pulmonologist decides that lung transplantation is a possible treatment option for you, he or she will contact the NewYork-Presbyterian Center for Advanced Lung Disease and Transplantation at Columbia University Medical Center. The first goal of the program is to determine whether lung transplantation is the best and only option for each patient. The latest alternative treatment strategies can sometimes enable patients to defer or if ever avoid transplantation. Once it has been confirmed that you have received optimal treatment with no significant success, then the next step is to evaluate whether you are a suitable candidate for lung transplantation.
Guidelines for Lung Transplantation
- Aged less than 75 years
- No acute or chronic illness
- No other significant organ dysfunction
- No active cancer for at least two years
- Abstinent from all tobacco/nicotine, alcohol, and drug use for at least 6 months
- History of compliance with follow-up visits and medications
- No significant and active psychiatric problems
- Current body mass index of less (BMI) than 35 and less than 32 at time of listing
- Be able to pass a standard six-minute walk test and participation in a pulmonary rehabilitation program
- No active infection with certain difficult-to-treat illnesses
Your physician will send all your medical records and a letter outlining your case to the program's Medical Director, a pulmonologist. He and a transplant coordinator will review your records. Your physician should send this information to:
Lung Transplant Office
Columbia University Medical Center
622 West 168th Street – PH 14 East, Room 104
New York, NY 10032
The transplant team will contact you and your referring physician by telephone or letter following the chart review. If it has been determined that you could be a possible candidate for lung transplantation, an appointment will be scheduled for your initial evaluation within the following four weeks.
For your pre-transplant evaluation – as well as all your pre-transplant and post-transplant care – you will go to the new state-of-the-art
Beverly & Arthur Shorin Comprehensive Transplant Outpatient Center at Columbia University Medical Center
622 West 168th Street – PH 14
New York, New York 10032
The initial consultation will last several hours. During that time, you will meet with six members of the lung transplantation team: the pulmonologist, surgeon, coordinator, social worker, psychiatrist and financial counselor. The purpose of this consultation is twofold: 1) to determine if you are a suitable candidate for transplantation and 2) to educate you and your family about all aspects of lung transplantation.
You can expect the following during this consultation:
- You will be examined by the transplant pulmonologist, surgeon and coordinator who will also take a detailed medical history and review your medical records as well as recent chest x-ray films and other relevant test results, such as CT scans.
- The social worker and psychiatrist will each conduct a basic psycho-social evaluation. At that time, the social worker will look into the extent of your social support system – those people who can assist in your care at home following your surgery.
- The financial counselor will evaluate your medical insurance and determine if the plan provides coverage for your lung transplantation. Often, in collaboration with your social worker, the counselor will work closely with you to ensure that all possible expenses, including cost of your many medications, will be covered, perhaps through new or additional insurance — or sometimes alternative sources.
- You and your family will learn about the evaluation process, organ allocation, the potential risks and benefits of lung transplantation, the surgery itself, the post-operative recovery period and the inevitable lifestyle changes, and the mandatory medications you'll be taking for the rest of your life. You will have the opportunity to discuss any concerns you may have.
A letter summarizing the results of this initial evaluation will be sent to your referring physician.
If the initial evaluation indicates that you may potentially benefit from lung transplantation, then you will be required to undergo a battery of tests. These tests will be performed over two to three days at Columbia University Medical Center within four to six weeks following the initial consultation. The tests will include:
- Chest x-ray and, in selected patients, CT scan
- Quantitative ventilation-perfusion lung scan
- Echocardiogram and electrocardiogram
- Complete pulmonary function tests and arterial blood gas
- Six-minute walk test and cardiopulmonary exercise study
- Right heart catheterization; in patients above age 45 and with risk factors for coronary artery disease — left heart catheterization for coronary angiography
- Cardiac stress test in selected patients
- DEXA (dual energy x-ray absorptiometry) to measure bone density
- Blood and urine testing
- Testing for blood and tissue type
- Antibody testing to measure the immune system's level of activity
- Barium upper gastrointestinal series in selected patients
- PPD and anergy testing for tuberculosis
- Dental evaluation
And, as part of general health maintenance:
- Women: Gynecologic evaluation with PAP smear (if have not had this test within a year)
- Women over 40: Mammography (if have not had this test within a year)
- Men over 40: PSA (prostate specific antigen)
- Patients at average risk for colorectal cancer over 50: Three-sample fecal occult-blood testing and sigmoidoscopy if have not had these in past five years – or a colonoscopy if have not had this test in ten years
- Patients with risk factors for colon cancer: A colonoscopy if they have not had one at an interval recommended by a physician
- Patients with bronchiectasis: Sputum culture
If necessary, you will be referred to other medical services such as gastroenterology and cardiology for further evaluation.
Once all your tests and medical consultations have been completed, the multidisciplinary lung transplantation team will review all your data at its weekly meeting and determine whether transplantation is the right treatment for you. If the team decides that you are a suitable candidate:
- You will be immediately registered with the United Network for Organ Sharing (UNOS), a not-for-profit organization contracted by the federal government to operate a patient waiting list and organ matching system. It assures equal access for every patient needing an organ for transplantation.
- The transplant physician and coordinator will meet with you and members of your family to discuss the decision. (You will also have this meeting even if you are not selected as a transplant candidate.)
- A letter detailing the team's decision as well as a summary of the testing will be sent to your referring physician.
- You will receive a letter documenting the date of the UNOS listing and the requirements for remaining on the list.