Your own physician will make a referral for you to be evaluated for whether a transplant may be appropriate at Ohio State's Wexner Medical Center. Here are some of the steps in the pre-transplant referral process:
- The referring physician or other provider is responsible for providing the coordinator with all applicable medical information according to the transplant referral protocol provided at time of referral. This information is shared with physicians on the transplant team to see if testing for potential transplant listing should be scheduled.
- We will verify your coverage for initial testing with your insurance company before making your initial evaluation appointment. Our pre-transplant office and hospital business office will work with you to determine insurance availability and precertification requirements.
- Pre-transplant coordinators and business office staff then work together to meet insurance company requirements for evaluation and transplant procedure approval.
You will generally be scheduled for a full outpatient clinic evaluation to determine whether listing for transplant would be an appropriate option for you.
During your first appointment, you will meet the transplant coordinator and be scheduled for evaluation testing to be done at Ohio State's Wexner Medical Center.
The testing includes extensive pulmonary and cardiovascular testing, in addition to multiple tests that evaluate general health. Transplant candidates must be in good overall health, since the surgery is difficult and medications taken after transplant are very hard on several body systems including bones, kidneys and liver.
You will also have consultations with our social worker, transplant infectious disease specialists, pain and palliative care specialist, and other professionals who may be appropriate to your condition.
During your outpatient clinic evaluation visit, our goal is to have all the pre-transplant initial testing, lab work (including tissue typing) and an array of clinical testing, education, surgeon and pulmonologist interviews and social work consultation (see Psychosocial Evaluation below) completed as quickly as possible.
Every patient being evaluated for lung transplant will have a psychosocial assessment with many multiple-choice questions and with a social worker. The purpose of this evaluation is to help determine if you have the psychological stability, motivation and personal support to meet the challenges of transplantation.
The assessment will cover:
- Your insurance coverage and ability to afford surgical and medication expenses
- Your support system (including primary and secondary caregivers)
- Knowledge of the transplant process and coping skills required to deal with the stress of the waiting period, hospitalization and recovery
- Psychiatric history including any current psychiatric problems
- Compliance with medical appointments and medications
- Chemical dependency
Sometimes patients are referred to see a transplant psychologist for further assessment of any psychological factors that may interfere with transplant outcome.
After the psychosocial evaluation is complete, a report is written and sent to the transplant team with a recommendation about your suitability for transplant from a psychosocial perspective.
Success And Compliance in Transplant
Taking care of your new lungs can determine your success after transplant. Maintaining a healthy lifestyle and changing harmful habits should be a priority. We expect our patients to participate in pulmonary rehabilitation. Our program does not consider patients who are current smokers or alcohol or drug dependent. Potential recipients must be substance-free for at least six months before being listed for transplant. We will perform random testing. A positive test result could result in removal from our list. Our program has no tolerance for tobacco use nor alcohol or drug abuse. Lung transplant recipients who return to smoking will not be considered for re-transplant.
If you are deemed a candidate for lung transplant, you will be asked to sign a written contract that states you understand and agree to commit to the process. If you have a tobacco, alcohol or drug history, you will be asked to sign an abstinence agreement as well. Sample contracts are available from your lung transplant coordinator and in our written materials. Please talk with your coordinator should you have any questions regarding these contracts and agreements.
During the pre-transplant evaluation, patients take part in a comprehensive education program that details the surgical procedure, medications, recovery and rehabilitation associated with the transplant process. During the pre-transplant period, the main focus is on educating you and your family about the following:
- Your responsibilities and role in the process
- What happens clinically during surgery and recovery
- Potential complications
- Lifestyle modifications
- Drug therapy
- Cost factors
- Support groups
- Further evaluation
Transplant physicians send follow-up letters to the referring physician summarizing the pre-transplant clinic visit and any additional information required. Once the evaluation is complete, we submit the clinical data received for insurance authorization.
Moving Toward Transplant
Following initial testing, the transplant team evaluates the information gathered and determines whether transplantation is appropriate. We will also determine what additional information is needed prior to placing you on the transplant list. These tests are customized based on your history and conditions, thus avoiding unnecessary testing and costs. It is preferred that these tests be completed at Ohio State's Wexner Medical Center, but depending on your geographic location or payer preference, they may be completed closer to your home. Ask your coordinator if this is an option for you.
Once the evaluation is complete, your coordinator will present your case to The Ohio State Wexner Medical Center patient selection committee for approval. Then, the final step involves approval by the Ohio Solid Organ Transplantation Consortium (OSOTC).
The OSOTC has a committee comprised of representatives from other transplant programs and other members who approve all patients for lung transplant listing in the state of Ohio. When approved by the OSOTC, you are then listed for lung transplantation on the United Network for Organ Sharing (UNOS) national waiting list. Patients are not actively listed for transplant until insurance approval is received.
Your wait time can depend on multiple factors such as your blood type, body size and the severity of your illness. The wait time could be from days to years.
During the waiting period, you will continue to follow-up periodically with Ohio State's transplant physicians so we may update your Lung Allocation Score (LAS) every two-three months. You must submit to random drug, nicotine, alcohol screening. You must be reachable at all times, usually with a cell phone. You should continue with pulmonary rehabilitation activities.
Also after listing, you will meet with our social worker and transplant coordinator, as will your family and any support persons identified for an orientation. You will sign a contract which details patient expectations and outlines expectations patients can have of Ohio State’s lung transplant team.
Please view During Your Transplant for more information.