TABLE 1

International urgency criteria in lung transplantation

Country/regionEmergency criteriaValid forConsequence
France [4]COPD/re-do transplantation: no priority
All other indications: MV or ECMO
CF: PaCO2 >80 mmHg despite NIV
ILD: SpO2 <90% despite high flow oxygen or oxygen mask
Vascular diseases: functional class IV, CI <2 L·min−1·m−2 and pulmonary vascular resistance >1200 dyn·s·cm−5
8 days (maximum 16 days)From regional to national priority
Italy [10]Invasive MV or extracorporeal support (except CO2 removal systems), previously listed
Age <50 years
BMI between 18 and 30 kg·m−2
1 week (maximum 3 weeks)
Spain [11]Invasive MV/ECMO, or PAH in life threatening condition despite adequate therapyNAFrom regional to national priority
Switzerland [12]Invasive MV or ECMO
Pulmonary fibrosis
Pulmonary vascular diseases
Age under 40 years (if donor <40 years)
4 weeksReordering within existing wait list
UK [13]Tier 1: extracorporeal support, if previously listed
Tier 2: COPD: PCO2 >49 mmHg/pH <7.3. despite 24 h NIV or >10 L·min−1 O2 or right heart failure despite therapy
CF: PCO2 >49 mmHg/pH <7.3 despite 24 h NIV or >10 L·min−1 O2 or right heart failure or haemoptysis after embolization
ILD: >10 L·min−1 O2 or right heart failure despite therapy
PAH: right heart failure or CI <2 L·min−1·m−2 and CVP >20 mmHg or continuous inotropes
NAFrom regional to national priority
Scandiatransplant [14]Supranational tier 1: extracorporeal circulatory support (or ventilatory support)
Supranational tier 2: patient with a rapid progression of organ failure with poor prognosis in a short time as defined by the responsible centre
3 patients per year and centre (total for both tiers)Both tiers promote patient from national to supranational priority
Belgium [15]Centre allocation (clinical discretion), LAS 50 or above qualifies for international urgency in Eurotransplant area14 daysFrom regional to international priority
Austria [15]Centre allocation (clinical discretion), LAS 50 or above qualifies for international urgency in Eurotransplant area14 daysFrom regional to international priority
Germany [15]National allocation by LAS, LAS 50 or above qualifies for international urgency in Eurotransplant area
Rescue allocation (organs declined elsewhere) allocated by centre discretion
National and international priority
Canada [16]Centre allocation, two urgency tiers defined by criteriaRegional priority
Australia and New Zealand [17]Centre allocation, fulfilment of certain criteria of urgency and HLA sensitisation may be considered for national allocationPossibly from regional to national
USA [18]LAS (and physical distance)Highest LAS has first priority within radius of 250 nautical miles from procurement centre

ECMO: extracorporeal membrane oxygenation; MV: mechanical ventilation; NIV: non-invasive ventilation; NA: not available; CF: cystic fibrosis; ILD: interstitial lung diseases; PAH: pulmonary artery hypertension; BMI: body mass index; PaCO2: arterial partial pressure of carbon dioxide; PCO2: partial pressure of carbon dioxide; SpO2: peripheral oxygen saturation; CI: cardiac index; CVP: central venous pressure; LAS: lung allocation score; HLA: human leukocyte antigen.