Candidate selection for lung transplantation - considerations beyond the medical evidence

The scarcity of organs available for lung transplantation makes it necessary to develop consistent practices for candidate selection and organ allocation. Such policies are mainly built on prognostic estimations, which are again built on medical evidence. In addition, however, other factors also guide these practices. These factors are not always explicit. The purpose of this review is to discuss some of these factors.

While one candidate may be considered to be in need of a transplant, the extent to which this need is weighed up against other patients at need varies, depending on how societal responsibility is conceived at the transplant center. Individual survival benefit may be in conflict with the concept of a just distribution of life years ('fair innings'). Furthermore, the need to expand medical knowledge, and the perceived patient autonomy and right to choose may affect the selection and allocation practices. Finally, financial considerations and nationality may have great influence.

Although well trained in medical judgment, the clinicians' candidate selection for lung transplantation is often influenced by factors beyond the medical evidence. These factors should be discussed just as transparently and accountably as the medical judgments.