The evaluation process helps you learn more about a transplant from the transplant experts and make a fully informed decision about whether a lung transplant is right for you.
The evaluation process involves many tests and consultations and may take up to several weeks. You will sometimes have to travel to the transplant center and stay nearby until the evaluation is complete. If you need help finding or paying for a place to stay, you can ask your transplant center if they offer accommodation assistance.
Like your cystic fibrosis care team, there is a multidisciplinary transplant team. This team of health care professionals is highly trained to support transplant candidates. During the evaluation, you will meet the members of the transplant team, which may include:
- Transplant surgeon
- Transplant pulmonologist
- Transplant nurse coordinators
- Social workers
- Physical therapists
- Respiratory therapists
- Dietitians
- Financial coordinators
During the evaluation process, the transplant team will review your physical health, psychological health, finances, and any potential factors that might prevent you from having a successful transplant. The team considers all these factors to determine if you are eligible for a lung transplant.
It might feel uncomfortable to have certain aspects of your life and health examined by people you've only just met. But the evaluation is essential to help the team members learn as much as possible about you so they can ensure that having a lung transplant will not be harmful to you.
At the end of the evaluation, the transplant team will meet to discuss your results and decide whether a lung transplant is appropriate.
Medical Evaluation
You will undergo extensive testing that will help the doctors on the transplant team understand how well your body is functioning. The results of the tests will show how well your lungs, heart, and kidneys work. Other tests will be done to determine what kinds of germs you have in your lungs. These tests may take several weeks.
Possible tests done during an evaluation may include:
- Blood and urine tests
- Lung function tests
- Electrocardiogram (EKG), a measure of your heartbeat
- Imaging tests, including a CT scan and ultrasounds of the heart and abdomen
- Cardiac catheterization (inserting a small tube into your arteries)
- Six-minute walk test
- Ph manometry test (a test of the esophagus)
- Bone density scan
- Screenings for colon cancer, breast cancer and cervical cancer
- A skin test for tuberculosis
The results of these tests might require further testing, or they might determine that you would not be a good candidate for a transplant at their center. Having an untreatable kidney disease is one example of something that might prevent you from moving forward in the transplant process at centers that will not consider multiple organ transplants.
Psychological Evaluation
The transplant process is difficult emotionally as well as physically. The transplant team needs to be sure that you will have the emotional strength and support you need to cope with the challenges that you will face before, during, and after transplant.
For this part of the evaluation, you will meet with a social worker or a psychologist who will gather information about you, your family, and your support system. Your ability to take medications every day as prescribed and abstain from smoking or illegal drug use will also be evaluated.
The psychological evaluation may result in the transplant team deciding that a transplant is not a good option for you. Having an inadequate support system is an example of something that might prevent you from doing well after a transplant and, therefore, prevent you from being put on the transplant list. If this is a barrier for you, talk with your transplant team about how they can help you find support.
Financial Evaluation
You will meet with a financial coordinator who will look at your finances, help you understand what your insurance provider will cover, and help you plan for how you will pay for the expenses that are not covered. It is important to know that transplant candidates must show the financial coordinator that they can pay their share of the transplant costs and post-transplant care.
If the financial coordinator determines that you have insufficient financial resources to pay for your pre- and post-transplant needs, such as medication co-pays or relocation expenses — which are not often covered by insurance — you may not be recommended to move forward in the transplant process.
If you need help with financial resources, call CF Foundation Compass. Compass is a personalized service that can help you understand insurance coverage, find financial resources, explore fundraising and grant options, and help with other challenges. You can contact Compass at 844-COMPASS (1-844-266-7277) or compass@cff.org.
Selection Committee Approval
The transplant team will use the information gathered during the evaluation to determine if having a lung transplant is in your best interest during a transplant selection committee meeting. During this meeting, the transplant committee will determine that you will be approved for listing or not approved. Candidates may not be approved for listing due to one or more of these reasons:
- You have decided not to pursue transplant as a treatment option.
- You are too sick to undergo the surgery.
- Additional testing needs to be done, or barriers need to be addressed.
- You have factors that would lead the transplant team to conclude that transplant could be harmful to you.
- You are currently too well to be listed
If you are approved for listing by the transplant center’s lung transplant selection committee, you will be added to the United Network for Organ Sharing (UNOS) national waiting list for donor lungs. Your status on the list may change based on your evolving disease severity or development of barriers after being listed. Contact the transplant nurse coordinator at your transplant center if you have any questions about your status on the waiting list.