Transplant and Pulmonary Hypertension

The Lung Allocation Score

Once you have a transplant team, your priority for transplant must be established. Until the spring of 2005, lung transplant priority was based on the amount of time candidates were on the waiting list. In order to more effectively utilize available organs the lung allocation guidelines were revised in 2005 so that each candidate is now given a score reflecting both the severity of each candidate's illness and their potential for post-transplant success. This score is termed the Lung Allocation Score (LAS), below are several important facts about the LAS, however more information can be found from the United Network for Organ Sharing's website or by phone at 1-888-894-6361.

  • All lung transplant candidates ages 12 and up receive a lung allocation score.
  • Candidates below the age of 12 are prioritized based on their time on the waiting list, blood type and distance from the hospital.
  • The LAS scale ranges from 0-100; a higher score reflects a higher priority for transplant.
  • Individuals with certain coexisting medical conditions are not eligible for transplant. These conditions include: 
    • HIV infection
    • Bone marrow failure
    • Cirrhosis of the liver or active hepatitis B or C infection
    • Chronic renal failure
    • Malignancy precluding long-term survival (a history of cancer does not necessarily disqualify you for transplant; speak with your doctor if you have questions)
    • Other life-limiting conditions
    • Active tobacco smoking or substance abuse
    • Significant coronary artery disease or peripheral vascular disease
    • Severe symptomatic osteoporosis
    • Sputum growing antibiotic pan-resistant bacteria
  • An individual's LAS is determined through a pre-transplant workup that is done prior to listing. Medical information used to determine the LAS includes:
    • Forced vital lung capacity
    • Pulmonary artery pressure
    • Oxygen levels at rest
    • Age
    • Body Mass Index
    • Insulin-dependent diabetes
    • Functional Status
    • 6-minute walk test
    • Ventilator use
    • Creatine levels
    • Diagnosis
  • This medical information must be updated every six months, and may be updated more often if your medical team deems it necessary.
  • If your medical professionals do not feel that your score fully reflects your circumstances, they can ask that it be reviewed and possibly altered by the Lung Review Board.
  • The special guidelines approved by the Lung Review Board when considering an appeal for a patient with pulmonary hypertension are the presence of 1) patient deteriorating on optimal therapy, 2) right atrial pressure greater than 15 mm Hg, and 3) cardiac index less than 1.8 L/min/m2. If these criteria are met and the appeal is approved, then the LAS is increased to the 90th percentile of all the LAS's nationally at the time of the request.
  • There is no minimum LAS necessary to receive a transplant. When lungs become available, the hospital will do a "match run" of the waiting list to determine candidates in the area with matching blood type. The matching candidate with the highest LAS will have the priority to receive the transplant.
  • In the case that two candidates in the area have the same LAS, wait time will be used to break the tie. This is the only case in which wait time is used to determine priority for candidates over the age of 12.
  • The medical team at the transplant center and the candidate will always have the choice to determine whether a transplant is the right action at that time and whether the lungs that become available are the right lungs.

Language Based on Treatment Fact Sheet Issued by PHA's Scientific Leadership Council

To review Conflict of Interest Disclosures for PHA's medical leadership, visit: Disclosures
Last reviewed in 2009

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