Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation

TLDR

Tens of thousands of patients with advanced lung diseases worldwide may be eligible for lung transplant, yet the timing of referral, evaluation, candidacy determination, and listing remains challenging and ethically fraught. The updated consensus document, developed by an international ISHLT group reviewing recent literature and advances, aims to help clinicians worldwide identify lung transplant candidates, optimize referral timing, and provide centers with a framework for evaluation and selection. The consensus process involved reviewing literature and advances, and the resulting document incorporates disease‑specific referral and listing recommendations, an ethical framework, recognition of center‑specific risk tolerance, and a system to weigh multiple risk factors in candidate selection. The updated consensus document offers disease‑.

Abstract

Tens of thousands of patients with advanced lung diseases may be eligible to be considered as potential candidates for lung transplant around the world each year. The timing of referral, evaluation, determination of candidacy, and listing of candidates continues to pose challenges and even ethical dilemmas. To address these challenges, the International Society for Heart and Lung Transplantation appointed an international group of members to review the literature, to consider recent advances in the management of advanced lung diseases, and to update prior consensus documents on the selection of lung transplant candidates. The purpose of this updated consensus document is to assist providers throughout the world who are caring for patients with pulmonary disease to identify potential candidates for lung transplant, to optimize the timing of the referral of these patients to lung transplant centers, and to provide transplant centers with a framework for evaluating and selecting candidates. In addition to addressing general considerations and providing disease specific recommendations for referral and listing, this updated consensus document includes an ethical framework, a recognition of the variability in acceptance of risk between transplant centers, and establishes a system to account for how a combination of risk factors may be taken into consideration in candidate selection for lung transplantation.