For those living with the specter of lung disease shortening their lifespan, one question is often asked that has never had a very good answer.

 

The question is:
“When should I get listed for a (double/single) lung transplant?” 

Until recently, it was a guessing game… a crap shoot… an educated guess based on very little hard data. In other words, for the most part, people chose to get evaluated and listed was based mainly on emotions and less on science.

 

That was until now. 

When should I get listed for a lung transplant? Finally, there is an answer for that. 

In the past, individuals suffering from lung disease needed to get listed for transplant at least 2 or more years before actually needing a transplant. Most transplant centers had a waiting list that meant that newly admitted individuals would have to wait their turn and that time waiting could often times run into two or more years. This wait time on the list led many patients, working with their doctors, getting listed well ahead of actually being ready to trade out the old lungs for the new - but there was no better way to go about getting in line in time. 

Unfortunately, that system was by its very nature skewed in favor of those patients who could wait 2 or 3 years on the list while their lung function slowly and predictably deteriorated. What it also meant was that those individuals whose disease process moved faster than the list could – those persons would often die during the wait. Clearly, the allocation methodology favored those who could withstand a multi-year wait at a good transplant center where they performed enough transplants to create a demand and a multiyear wait list. The only real alternative for those who couldn’t wait was to go find a transplant center where the wait list was shorter. Generally speaking, centers that did fewer transplants would have shorter wait times. Unfortunately, that also meant that such centers had less practice performing transplants and their outcomes were worse than those performed at the larger centers. The system was patently unfair to those who had an aggressive lung disease. 

It is for these very reasons that UNOS (the United Network for Organ Sharing) changed the lung allocation methodology to offer available lungs to the worst – first. Now it isn’t a matter of how long you have been waiting on the list at a given transplant center that determines if you get a chance at some lifesaving organs; it’s how sick you are combined with the ability to and are you able to withstand the rigors of transplantation. 

Within the lung disease community there is a base line test known as “The 6 Minute Walk”. It is used to determine how far an individual can walk in 6 minutes. The distance that someone might be able to walk on a picture perfect day where all that person’s variables are working in their favor might have a much better walk than they themselves or someone else might have after having eaten a heavy lunch and walking a mile on their own just to get to the test. These real life variables can and do influence how well someone performs in their test. 

But when you get down to it….when you compare apples to apples – comparing good and/or bad 6 minute walks to other 6 minute walks – research is showing something very interesting. 

In the past, when to get listed for transplant was a very subjective decision. Rarely would two individuals use the same set of criteria to come to that point where they say – “I want to get a lung transplant”. Fortunately for the lung affected community there appears to be strong evidence from a recent study that shows that optimal time for getting a transplant would be when the patient can complete the 6 minute walk and cover 400 meters. That translates roughly to 2.2 MPH for 6 minutes. For someone with severe lung disease that is quite a challenge but I may be a little biased since I am nowhere near able to make 400 meters in 6 minutes. 

Based on a study at the NIH (National Institutes of Health) -
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714545/

They showed that the best survival rates occurred in those individuals who received transplantation when they got listed for transplant when they could no longer complete 400 meters in 6 minutes. That is roughly the equivalent of walking at two and a half miles an hour for 6 minutes – covering 1313 feet. 

On the other side of the coin, according to the Indiana University Lung Transplant program in Indianapolis, IN. they require that patients be able to walk a minimum of 700 – 800 feet in 6 minutes. That means that the prospective transplant patient needs to walk at a speed of between 1.3259 and 1.5160 MPH for at least 6 minutes in order to meet the minimum required distance to be considered for a lung transplantation. 

In a nutshell: 
If your 6 minute walk in under that – you should get listed for transplant. But if you are under the minimum, you need to get into pulmonary rehab and get up to that minimum as soon as you can. 
If you are over, you are still too healthy to get listed. That is a good thing! 
It has always been a moving target for clinicians and patients to determine when the time is right to go through the rigors of transplantation evaluation but at least now, with this study to guide us, we now know when we should make that call to the transplant center and start the process. 
Below is a table I put together to show some of the goalposts in how to determine if you are ready to pursue transplant.

 

Speed in MPH

Distance covered in 6 minutes

 

0.60 / 316.80 
0.70 / 369.60 
0.80 / 422.40 
0.90 / 475.20 
1.00 / 528.00 
1.10 / 580.80 
1.20 / 633.60 
1.30 / 686.40 

1.3259 / 700.08 Minimum Txp.Range. Start
1.40 / 739.20 
1.50 / 792.00 
1.5160 / 800.45 Minimum Txp. Range. End 

1.60 / 844.80 
1.70 / 897.60 
1.80 / 950.40 
1.90 / 1003.20 
2.00 / 1056.00 
2.10 / 1108.80 
2.20 / 1161.60 
2.30 / 1214.40 
2.40 / 1267.20

2.49 / 1312.3440 400 meters

2.50 / 1320.00 
2.60 / 1372.80 
2.70 / 1425.60 
2.80 / 1478.40 
2.90 / 1531.20 
3.00 / 1584.00 
3.10 / 1636.80 
3.20 / 1689.60 
3.30 / 1742.40 
3.40 / 1795.20 
3.50 / 1848.00 
3.60 / 1900.80 
3.70 / 1953.60 
3.80 / 2006.40 
3.90 / 2059.20 
4.00 / 2112.00 

So there you have it.

 

If you can walk more than 400 meters (1312.3440 feet to be precise) in 6 minutes, congratulations… you are too healthy still to consider getting a transplant. If, on the other hand, you are under that – perhaps it is time to get listed.

 

Now, if you can’t cover between 700 to 800 feet in 6 minutes, you should get yourself to a pulmonary rehabilitation program pronto in order to get yourself up to that level of fitness.

 

Transplant centers are very particular about giving organs to people who are not healthy enough to withstand the transplant surgery and recovery process. There are other criteria to be sure… but this article isn’t trying to address those issues. Just this one… and it’s a big one.

 

Good luck and God Bless.