How to Get Added to a Lung Transplant Waiting List

A Keck Medicine of USC expert explains the eligibility and evaluation processes.

If you or a loved one is dealing with severe lung disease, a lung transplant may be an option. Understanding the process of getting on a lung transplant waiting list is an important first step in this journey. 

“Lung transplantation exchanges the whole lung for a new lung,” explains Takashi Harano, MD. Dr. Harano is a thoracic and lung transplant surgeon with the USC Lung Transplantation Program, part of the USC Transplant Institute and Keck Medicine of USC.  

Lung transplants, though rare, are becoming more common. In 2023, lung transplants exceeded 3,000 for the first time in the United States and rose to more than 3,200 in 2024, according to the United Network for Organ Sharing.  

What to know about a lung transplant 

A lung transplant is reserved for patients with end-stage lung disease who have exhausted other treatment options. Patients must take lifelong anti-rejection medications afterward. 

The most common condition leading to lung transplantation is pulmonary fibrosis, a condition in which stiffened lung tissue prevents proper breathing. This progressive condition has no cure, Dr. Harano explains. 

Other qualifying conditions include chronic obstructive pulmonary disease (COPD), cystic fibrosis, pulmonary hypertension and severe bronchiectasis. 

Who is eligible for a lung transplant? 

The journey begins when a patient’s condition worsens despite optimal therapy. “When the patient starts struggling with breathing and starts using supplemental oxygen, a pulmonologist, or lung specialist, may introduce the patient to the idea of lung transplantation,” Dr. Harano says. 

A general pulmonologist will then typically refer a patient to a specialized lung transplant center — the first official step in transplant evaluation. A multidisciplinary team including transplant pulmonologists, surgeons, physical/occupational therapists, social workers, pharmacists and dieticians evaluate the patient’s case. They assess all medical and social aspects to decide whether the patient will be a good candidate for a lung transplant. 

To qualify for a lung transplant, patients must: 

• Have end-stage lung disease 
• Have exhausted other treatment options 
• Be physically fit aside from their lung disease. (Well-controlled conditions such as diabetes and hypertension are not disqualifiers.) 
• Not have severe disease in other organs. (If there are any concerns regarding the health of other organs, the medical team will carefully assess the need for dual-organ transplantation, such as heart and lung, lung and liver, or lung and kidney, Dr. Harano says.) 

While there is no absolute age cutoff for eligibility, Dr. Harano says patients over 70 may face more selective criteria. Patients must also be substance-free (no smoking, alcohol, vaping, marijuana, etc.) for at least six months. 

Having a strong support network is also critical to a patient’s transplant success. This support system helps navigate the challenges of post-transplant life, including medication management and follow-up appointments. 

Insurance approval is also essential. Most transplant centers work with patients’ insurance companies for preauthorization before proceeding. 

The lung transplant evaluation process 

Transplant evaluation involves numerous tests to assess a patient’s overall health and suitability for transplant: 

• Blood tests for organ function, infectious status and immunizations (must be up to date)  
• Heart health tests, including echocardiogram and cardiac catheterization 
• Imaging studies (CT scans of the head, chest and abdomen) 
• Vascular assessment of the neck 
• Pulmonary function tests 
• Exercise capacity tests (six-minute walk test) 
• Swallowing assessment to check for the risk of accidentally inhaling food or liquid 

The evaluation process typically takes three to six months, but “if patients are getting very sick, we complete their evaluation as inpatients and can finish it within a week,” Dr. Harano adds. 

Getting added to a lung transplant waiting list 

Transplant patients receive a composite allocation score (CAS) determining their priority for available organs. The CAS considers medical urgency, expected benefit from a transplant, physical distance from the donor, and compatibility factors. 

Medical urgency is a primary factor. “If the patient requires a higher amount of supplemental oxygen, they can be prioritized to get a lung transplant more quickly,” Dr. Harano notes.  

Patients with acute illnesses like flu are temporarily removed from the waiting list until they recover because they can’t safely undergo transplant surgery while sick. However, if the patient is getting sick from their lung disease, they can remain on the list as a candidate. Dr. Harano says these candidates are supported with a ventilator or even extracorporeal membrane oxygenation (ECMO, also known as a “heart-lung machine”). Candidates can also be dual listed at another transplant center, but this might only work in their favor if the two centers are located in different regions.  

Life on the lung transplant waiting list 

As they wait, lung transplant candidates should try to keep themselves as healthy as possible. “The most important thing is engaging in whatever physical activity they can do,” Dr. Harano emphasizes. Many patients work with physical therapists to develop safe exercise programs that they can engage in despite their breathing difficulties. 

Close communication with your transplant coordinator is critical, he adds. Report any changes in your condition promptly to ensure your listing status reflects your current needs. 

Waiting times vary based on medical urgency — from days for the critically ill to six months or even a year for more stable cases. 

During the emotionally challenging wait, transplant centers like the USC Transplant Institute offer monthly support meetings organized by social workers. In addition to supporting patients before transplantation, these groups lend support after transplantation, providing ongoing teaching and a place where patients can share their experiences within the Keck Medicine transplant community.  

When an organ becomes available, be ready to come to the hospital quickly. Keep your phone accessible, have transportation arranged, have a packed bag ready and have an updated medication list. 

Your transplant journey takes off 

Getting added to a lung transplant list requires careful evaluation and preparation. By understanding the process, you can position yourself for the best possible outcome. 

“We always keep encouraging patients that there is hope that they could get a transplant,” says Dr. Harano.

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