title: A consensus document for the selection of lung transplant candidates: 2014--an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation.
abstract: The appropriate selection of lung transplant recipients is an important determinant of outcomes. This consensus document is an update of the recipient selection guidelines published in 2006. The Pulmonary Council of the International Society for Heart and Lung Transplantation (ISHLT) organized a Writing Committee of international experts to provide consensus opinion regarding the appropriate timing of referral and listing of candidates for lung transplantation. A comprehensive search of the medical literature was conducted with the assistance of a medical librarian. Writing Committee members were assigned specific topics to research and discuss. The Chairs of the Writing Committee were responsible for evaluating the completeness of the literature search, providing editorial support for the manuscript, and organizing group discussions regarding its content. The consensus document makes specific recommendations regarding the timing of referral and of listing for lung transplantation. These recommendations include discussions not present in previous ISHLT guidelines, including lung allocation scores, bridging to transplant with mechanical circulatory and ventilator support, and expanded indications for lung transplantation. In the absence of high-grade evidence to support decision making, these consensus guidelines remain part of a continuum of expert opinion based on available studies and personal experience. Some positions are immutable. Although transplant is rightly a treatment of last resort for end-stage lung disease, early referral allows proper evaluation and thorough patient education. Subsequent waiting list activation implies a tacit agreement that transplant offers a significant individual survival advantage. It is both the challenge and the responsibility of the transplant community globally to ensure organ allocation maximizes the potential benefits of a scarce resource, thereby achieving that advantage.
authors.affiliation: Stanford University, Stanford, California. Electronic address: dweill@stanford.edu.
authors.forename: David
authors.initials: D
authors.lastname: Weill
authors.affiliation: University Hospital Zurich, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Benden
authors.affiliation: Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Corris
authors.affiliation: Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.
authors.forename: John H
authors.initials: JH
authors.lastname: Dark
authors.affiliation: Duke University, Durham, North Carolina.
authors.forename: R Duane
authors.initials: RD
authors.lastname: Davis
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
authors.affiliation: Columbia University, New York, New York.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lederer
authors.affiliation: University of Washington, Seattle, Washington.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mulligan
authors.affiliation: Washington University, St. Louis, Missouri.
authors.forename: G Alexander
authors.initials: GA
authors.lastname: Patterson
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lianne G
authors.initials: LG
authors.lastname: Singer
authors.affiliation: The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Greg I
authors.initials: GI
authors.lastname: Snell
authors.affiliation: University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Geert M
authors.initials: GM
authors.lastname: Verleden
authors.affiliation: University of Colorado, Denver, Colorado.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Zamora
authors.affiliation: St. Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: Allan R
authors.initials: AR
authors.lastname: Glanville
mesh_terms: D016041:Heart-Lung Transplantation / Q000379:methods*; D006801:Humans; D018579:Patient Selection; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D012955:Societies, Medical; D014019:Tissue Donors / Q000600:supply & distribution*; D014850:Waiting Lists
keywords: cystic fibrosis; emphysema; interstitial lung disease; lung transplantation; pulmonary hypertension