Malignancy with high risk of recurrence or death related to cancer |
Age >70 years |
Age 65–70 years |
Glomerular filtration rate <40 mL·min−1·1.73 m−2 unless being considered for multi-organ transplant |
Severe coronary artery disease that requires coronary artery bypass grafting at transplant |
Glomerular filtration rate 40–60 mL·min−1·1.73 m−2
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Acute coronary syndrome or myocardial infarction within 30 days |
Reduced left ventricular ejection fraction <40% |
Mild to moderate coronary artery disease |
Stroke within 30 days |
Significant cerebrovascular disease |
Severe coronary artery disease that can be treated via percutaneous coronary intervention prior to transplant |
Liver cirrhosis with portal hypertension or synthetic dysfunction unless being considered for multi-organ transplant |
Severe oesophageal dysmotility |
Patients with prior coronary artery bypass grafting |
Acute liver failure |
Untreatable haematologic disorders including bleeding diathesis, thrombophilia or severe bone marrow dysfunction |
Reduced left ventricular ejection fraction 40–50% |
Acute renal failure with rising creatinine or on dialysis and low likelihood of recovery |
Body mass index ≥35 kg·m−2
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Peripheral vascular disease |
Septic shock |
Body mass index <16 kg·m−2
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Severe gastro-oesophageal reflux disease |
Active extrapulmonary or disseminated infection |
Limited functional status with poor potential for post-transplant rehabilitation |
Oesophageal dysmotility |
Active tuberculosis infection |
Psychiatric, psychological or cognitive conditions with potential to interfere with medical adherence without sufficient support systems |
Thrombocytopenia, leukopenia or anaemia with high likelihood of persistence after transplant |
HIV infection with detectable viral load |
Unreliable support system or caregiving plan |
Osteoporosis |
Limited functional status (e.g. non-ambulatory) with poor potential for post-transplant rehabilitation |
Lack of understanding of disease and/or transplant despite teaching |
Body mass index 30–34.9 kg·m−2
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Progressive cognitive impairment |
Hepatitis B or C infection with detectable viral load and signs of liver fibrosis |
Body mass index 16–17 kg·m−2
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Repeated episodes of non-adherence without evidence of improvement |
Chest wall or spinal deformity expected to cause restriction after transplant |
Frailty |
Active substance use or dependence including current tobacco use, vaping, marijuana smoking or intravenous drug use |
Extracorporeal life support |
Hypoalbuminaemia |
Other severe uncontrolled medical condition expected to limit survival after transplant |
Redo transplant <1 year following initial lung transplant |
Poorly controlled diabetes |
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Redo transplant for restrictive chronic lung allograft dysfunction |
Edible marijuana use |
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Redo transplant for antibody mediated rejection |
HIV infection with undetectable viral load |
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Previous thoracic surgery |
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Prior pleurodesis |
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Mechanical ventilation |
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Redo transplant >1 year for obstructive chronic lung allograft dysfunction |