Introduction

Selection of appropriate candidates for lung transplantation, as it is for all solid organ transplantation, remains one of the most important elements of a successful outcome. Since the number of patients awaiting organs continues to significantly exceed the number of donor organs, it is important to ensure that patients who have far advanced pulmonary disease, but are otherwise medically appropriate, are selected. Optimal outcomes also require careful preoperative medical management. This chapter will address general health and disease-related selection criteria, elements of the selection process, medical management prior to transplantation and the selection of type of transplant.

General medical health

Transplant surgery itself is a major stressor for any patient with pulmonary failure; it is much more so when immunosuppressive medications have been started. In this milieu, comorbidities, even those which otherwise may seem trivial, can have an important negative impact on outcome.

In general, potential transplant candidates should be in excellent health except for their advanced lung disease. Since most of the patients who present for lung transplantation, however, are between 40 and 65 years old [1], it is not surprising that many have at least one comorbidity. In addition, the nature of many of the diseases/causes from which patients develop end-stage pulmonary disease, i.e. systemic illness such as cystic fibrosis or scleroderma, smoking-related chronic obstructive pulmonary disease (COPD), are such that comorbidities are expected as part of the entire picture.

Comorbidities that are optimally treated and, as a result, are well controlled such that they are unlikely to impact on the grafted lung or other vital organs are generally acceptable in the lung transplant candidate.