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Sunday, March 9, 2014
Lung Transplant Questions
A friend of mine is supposedly high on the list for transplantation.
How long is the wait? is the list long? What is the status of lung transplants in WI? Can an organ be obtained from out of state? My friend is working to keep mentally distracted. Would her chances be increased if she did not work? How could a person anonymously donate a lung to a specific person? Are there any advocacy groups for organ donation? Thank you.
The waiting times for lung transplantation can vary and are primarily determined by: the candidate's severity of illness (reflected, in part, by an assigned Lung Allocation Score), donor organ availability, and obtaining a suitable match (size and blood type) between donor and recipient. Consequently, the waiting times experienced at any given program are determined, in part, by these factors. As a result, waiting times can vary widely between institutions and even for candidates on an individual institution's list.
Some of the more prolific programs can have candidate waiting lists that approach 200 patients while other programs may have as few as 10 patients. Regardless of the size of the waiting list, an individual candidate's position on the list may be moved up or down based on the assigned allocation score. When an organ becomes available for transplantation, the organ is offered to the candidate who is a match and who has the highest score in the region where the donor is available. This region may encompass one or more transplant centers and therefore the candidate with the highest score in that region (not necessarily the highest score at a given transplant center) is offered the organ.Organ procurement does not generally follow state boundary lines but is related to the site where the donor is located. Organs are generally first offered to any potential matches within the immediate area adjacent to the donor. If no matching candidates are available, then the organ is offered to any other potential candidates that are located in successively increasing distances from the donor location. State boundaries are generally not considerations in this allocation scheme. The decision to continue at one's employment is quite individualized. Some patients need to continue working to maintain necessary tangible job related benefits. Depending on the type of physical exertion that their job requires, some patients may find it necessary to reduce or even suspend their workload to remain as physically fit as possible and thus remain suitable transplant candidates. Others find that continuing at their job gives them a sense of purpose and accomplishment and may actually help their mental fortitude. A lung transplant candidate should discuss these concerns with their physician so that the best decision can be made for that individual patient. There presently exists no format where a lung can be anonymously donated to a recipient. There exist a few programs in the United States where lobes from two living donors can be harvested and implanted into a recipient - each transplanted lobe assuming the entire function for one of the recipient's diseased and excised lungs. These are highly specific situations and not all candidates and donors qualify for this procedure. When a candidate does qualify, lobes are most often harvested from willing and compatible family members. A patient needs to discuss with their physician as to whether they are a candidate for this type of procedure. Two popular advocacy groups for lung transplantation are: Second Wind who can be contacted at 1-888-855-9463. United Network of Organ Sharing (UNOS).
David R Nunley, MD, FCCP
Former Associate Professor
College of Medicine
The Ohio State University