Preamble

The National Notification Lung Transplantation process described below is adapted from the ADTCA-TSANZ-OTA National Standard Operating Procedure - Organ Allocation, Organ Rotation, Urgent Listing – last reviewed in March 2023.

Indications

• Patient survival estimated to be days to weeks without transplantation as a result of or due to development of:
  • Requirement for ECMO
  • New or worsening respiratory failure needing high flow oxygen, non-invasive ventilation, or mechanical ventilation
  • Rapid deterioration as indicated by, but not limited to a significant rise in partial pressure of carbon dioxide, marked reduction in functional capacity, acute irreversible fall in lung function parameters or refractory right heart failure.

• Highly sensitised patient with high Panel Reactive Antibody or high titre anti-HLA antibodies, in order to enhance their overall exposure to a larger donor pool. Consideration should be given to initiate national notification for patients who are excluded from OrganMatch algorithm matching based on their unacceptable antigens.

• Unusual technical requirements – size extremes (small TLC) where size-matched organ availability is limited.

NB: These are for general guidance only rather than an automatic trigger for national notification, with institutional factors, prognosis and predicted outcome post transplantation influencing decision making.

National notification procedures

a. National notification for lung transplantation is at the discretion of the Lung Transplant Unit Director. It is the responsibility of the Lung Transplant Director (or their delegate) to notify all other Lung Transplant Units. It is not routine practice to notify DonateLife Agencies in Australia or Organ Donation New Zealand when a patient is placed on or removed from the national notification list.

b. A notification from one state is not binding on other states. A national notification does not override lung allocation standard procedures.

c. The donation coordinator will be informed by the home state lung transplant unit at the time of offering the lungs if the home state will waiver the offer for a patient on the national notification list.

d. In this circumstance the ADTCA-TSANZ-OTA Allocation Rotation is bypassed and the acceptance or decline of offer is not recorded on the rotation. The donation coordinator will record this offer in the EDR.

e. In the event the lungs are not accepted for the national notification patient, the lungs are offered back to the home state.

f. A patient listed for national notification will remain active for four weeks. If a patient remains on national notification beyond four weeks, re-notification of all Lung Transplant units is required.

Review

The operation of the national notification list will be subject to annual audit by the Lung Transplant Advisory Committee (LTAC) and be listed as a standing agenda item at LTAC meetings.