ABSTRACT
Lung transplantation is now a generally accepted therapy for the management of a wide range of severe lung disorders, with evidence supporting improved quality of life and survival benefit for lung transplant recipients (1). However, the number of donor organs available remains far fewer than the number of patients with end-stage lung disease who might potentially benefit from the procedure. It is of primary importance, therefore, to optimize the use of this resource, such that the selection of patients who receive a transplant represents those with realistic prospects of favorable long-term outcomes. There is a clear ethical responsibility to respect these altruistic gifts from all donor families and to balance the medical resource requirements of one potential recipient against those of others in their society. These concepts apply equally to listing a candidate with the intention of transplant and potentially delisting (perhaps only temporarily) a candidate whose health condition changes such that a successful outcome is no longer predicted.
