The first question that comes into people’s mind when they consider organ transplant is how long they will have to wait. There are so many factors affecting the wait time that it is very hard to say. For lung transplant, the main ones are type of disease, patient’s size and the transplant center itself. Also lung is the organ with the one of lowest wait time in organ transplant. Relatively less people are waiting for lungs versus the number of available organs compare with kidney or liver.
The way lungs are allocated is by a complicated calculation of different data from the patient. The number, or score, that the system gives after putting all the data in is called Lung Allocation Score (LAS). The patients are ranked by LAS score with the highest number being at the top. Those data are entered in the UNOS™ website by the transplant coordinator and they include the amount of oxygen used, pressure in the heart, 6 minute walk distance, etc. The number one factor that affects the score is the disease. Some disease like idiopathic pulmonary fibrosis (IPF) will be giving more points than chronic pulmonary obstructive disease (COPD). Patients with IPF are clinically sicker than COPD and their condition can get worst as quickly as overnight. Transplanting COPD patients is more about quality of life and is a more stable disease while many can live years without lung transplant.
Another very important factor in determining how long someone will have to wait is the size (height and weight) of the organ transplant candidate. A really small or very tall patient will most likely increase the wait time as few donors meet those dimensions. Being too small I think is worst than too tall. A very short adult patient may need lungs from a child or small teen but they will have to compete with pediatric patients who have priority on pediatrics organs. It is very hard to transplant a very small adult but with a little luck it can happen.
One more very important factor that you can’t really find in the books anywhere is how aggressive the lung transplant program is in pursuing lungs that other centers would turn down. Some pulmonologists will turn down lungs that are less than perfect without trying to improve them. It is important to mention that the lungs are the most fragile organs from the donors. Good lungs can turn bad very quickly if the donor is not managed properly. The OPO coordinator has a very important job to do in maintaining the quality of the lungs or to improve them. Lungs are susceptible to fluid overload and infection for the most part. Detailed attention is needed to keep the lungs fit for transplantation. Some transplant centers don’t bother in trying to salvage lungs. It is worth giving it a shot in a context of shortage of organs and it directly results in more lungs available for the more aggressive hospitals. It happened to me more than once after giving a first look at a lung offer from UNOS, I was certain we would decline due to bad quality. With a good physician giving the right orders about medication and making the perfect adjustment on the breathing machine, the lungs got much better and the patient received his lung transplant. Of course a little luck is needed too I believe.
The average wait time for a busy and proactive transplant center is about 3 months spent on the list for lung transplant. Some will have their organ transplant as early as the same week they were put on the list while others will wait on the list for months if not years. It is very unpredictable but in general it will be faster than the other organs like heart, kidney and liver. Also there is some period of time when we receive very few quality organ offers and other time where it is the opposite. The number of organ offers is pretty much the only thing that we can’t control at the transplant center level. If all the stars are aligned for you, you can get your transplant rather quickly!