Checklist for lung transplant pre-surgery preparations
Published: Sep 24, 2026
Updated: Sep 24, 2026
Published: Sep 24, 2026
Updated: Sep 24, 2026
For people living with advanced lung disease, lung transplantation can offer an opportunity for improved lung function, greater physical independence, and, in appropriately selected patients, longer survival. But the transplant operation itself is only one part of the journey.
Before surgery, patients typically undergo a detailed evaluation and preparation process designed to determine whether transplantation is appropriate, identify conditions that could increase surgical risk, and improve physical and psychological readiness for the procedure. This preparation may begin weeks or months before transplantation and can continue while a patient is on the waiting list.
The International Society for Heart and Lung Transplantation (ISHLT) emphasises that lung transplant assessment should consider not only the severity of lung disease but also nutritional status, frailty, comorbidities, psychosocial circumstances, health behaviours, and the patient's ability to participate in rehabilitation and long-term treatment.
For patients and families, having a practical checklist can make this complex process easier to understand.
Preparation area | What may need to be completed |
Medical evaluation | Complete transplant assessment and review of existing conditions |
Lung assessment | Pulmonary function tests, imaging, oxygenation and other respiratory tests |
Heart assessment | ECG, echocardiogram, stress testing or coronary evaluation when indicated |
Blood testing | Blood group, tissue typing, antibodies and routine laboratory tests |
Infection screening | Screening for bacterial, viral, fungal and other relevant infections |
Vaccination | Review and update recommended immunisations before transplantation |
Smoking cessation | Complete abstinence from tobacco, vaping and other nicotine exposure as required by the transplant program |
Nutrition | Assess weight, muscle mass and nutritional deficiencies |
Physical conditioning | Participate in pulmonary rehabilitation or an individualised exercise program |
Dental health | Identify and treat significant dental or oral infections |
Medication review | Review prescription, OTC, herbal and supplement use |
Psychosocial preparation | Assess mental health, adherence, caregiver support and practical circumstances |
Caregiver planning | Identify a reliable caregiver/support person |
Post-transplant planning | Arrange transportation, accommodation, follow-up and financial/logistical needs |
Emergency readiness | Keep contact details updated and remain available for a donor-organ call |
The exact requirements vary among transplant centres and according to the patient's underlying disease, age, comorbidities and clinical condition.
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The first major step is a comprehensive transplant evaluation. The purpose is not simply to confirm that the lungs are severely damaged. The transplant team must determine whether the patient's overall health is compatible with major surgery and lifelong immunosuppressive treatment.
Evaluation may involve a pulmonologist, transplant surgeon, cardiologist, infectious disease specialist, dietitian, physiotherapist, psychologist or psychiatrist, social worker and other specialists.
The evaluation commonly examines:
The Blood and Transplant service notes that extensive testing is needed to determine whether a patient is sufficiently well to undergo major surgery, with each transplant centre establishing its own detailed requirements.
A lung transplant involves major surgery followed by lifelong immunosuppression. Therefore, untreated infection, uncontrolled comorbidities, poor nutritional status or inadequate rehabilitation potential may need to be addressed before transplantation.
Patients can expect several investigations to evaluate the condition of their lungs and determine how well other organs may tolerate transplantation.
Test or assessment | Why it may be performed |
Spirometry and pulmonary function tests | Measures lung function and disease severity |
Chest X-ray | Provides an overview of lung and chest abnormalities |
CT scan | Provides detailed anatomical information |
Arterial blood gas | Evaluates oxygenation and carbon dioxide levels |
Six-minute walk test | Assesses functional exercise capacity |
Echocardiogram | Evaluates cardiac structure and function |
ECG | Checks cardiac rhythm and electrical activity |
Right-heart catheterisation | Measures pulmonary and cardiac pressures when indicated |
Coronary assessment | Identifies significant coronary artery disease when clinically appropriate |
Bone-density testing | Assesses osteoporosis risk |
Abdominal imaging | May identify abnormalities in other organs |
The Blood and Transplant Centre lists lung function testing, chest imaging, ECG, echocardiography, coronary assessment, right-heart catheterisation, and other investigations as tests that may form part of the assessment.
Not every patient requires every test. The transplant team determines the appropriate investigations based on the individual's medical history.
Blood testing is another important part of preparation.
Tests may assess:
One important consideration is HLA sensitisation. Patients with elevated antibodies against certain human leukocyte antigens may have greater difficulty finding a compatible donor, depending on their antibody profile and the transplant program's matching process.
Patients should therefore keep their transplant team informed about previous transfusions, pregnancies, prior transplantation, and other relevant medical events, as these may influence immunological assessment.
Infection prevention becomes particularly important because transplantation requires immunosuppressive medication, which reduces the immune system's ability to fight infections.
Pre-transplant infectious disease assessment may include evaluation for:
Other infections based on geographical exposure and medical history
The infectious disease evaluation also considers previous infections, travel history, occupational exposure, animal contact and other potential sources of infectious risk.
An active or poorly controlled infection may need to be treated before transplantation. This is one reason patients should promptly report fever, new respiratory symptoms, urinary symptoms, skin infections or other signs of infection to their medical team.
Vaccination should ideally be addressed before transplantation rather than left until after surgery.
The ISHLT's 2025 statement emphasises the importance of vaccination for lung transplant candidates and recipients and recommends that immunisation opportunities be addressed appropriately before transplantation.
The transplant team may review vaccination status for diseases such as:
Some vaccines require multiple doses or time to develop an adequate immune response. In addition, live vaccines generally cannot be administered after transplantation because of immunosuppression, making pre-transplant planning particularly important.
Important: Patients should not independently receive vaccines immediately before transplantation. The transplant team should determine which vaccines are appropriate and when they should be administered.
Smoking cessation is one of the most important modifiable aspects of transplant preparation.
Transplant programs generally require evidence of sustained abstinence from tobacco and other nicotine products. The ISHLT specifically highlights abstinence from tobacco and nicotine, including vaping, as an important consideration in lung transplant candidates.
Patients should also minimise exposure to:
Some transplant centres use biochemical testing, such as cotinine testing, to objectively assess nicotine exposure.
If quitting is difficult, patients should discuss cessation support with their healthcare team rather than attempting to manage it alone.
Severe lung disease can cause significant muscle weakness, inactivity and loss of exercise capacity. This can make recovery from major surgery more challenging.
For this reason, pulmonary rehabilitation and prehabilitation may form an important part of transplant preparation.
The ISHLT recommends pre- and post-transplant pulmonary rehabilitation for appropriate candidates, while evidence-informed transplant rehabilitation approaches emphasise maintaining muscle strength and functional capacity.
A rehabilitation program may include:
Exercise intensity must be individualised. Someone with advanced respiratory disease should not begin an intensive exercise program without guidance from their transplant or pulmonary rehabilitation team.
Nutritional status can influence transplant readiness and recovery.
Both severe undernutrition and significant obesity can create challenges during transplantation. The ISHLT identifies BMI, hypoalbuminemia and frailty among factors that may influence outcomes.
A transplant dietitian may assess:
Patients who are underweight may require nutritional support to improve energy and protein intake. Conversely, patients with obesity may be advised to achieve gradual, medically supervised weight reduction.
The goal is not simply to reach a particular number on the weighing scale. Preserving muscle mass and improving overall nutritional and functional status are equally important.
Frailty is increasingly recognised as an important factor in transplant assessment.
Patients with advanced lung disease may experience:
ISHLT guidance notes that frailty is associated with increased waitlist and post-transplant mortality, while also recognising that some frailty related to advanced lung disease may improve after transplantation.
This makes pre-transplant physical conditioning valuable even when complete reversal of frailty is not possible.
Dental problems can become particularly important when a patient is expected to receive long-term immunosuppression.
Untreated dental infections or significant oral disease may need to be addressed before transplantation. A dental evaluation can help identify:
Patients should inform both the dentist and transplant team that they are undergoing transplant evaluation. Any invasive dental procedure should be coordinated with the transplant team, particularly when the transplant is imminent.
Before surgery, the transplant team should know about everything the patient takes, including:
Some medications may need dose adjustment or temporary discontinuation around surgery.
Patients should never stop an important medication without medical advice, particularly medicines used to control pulmonary hypertension, heart disease, seizures or other serious conditions.
The transplant team may need to optimise conditions that could affect surgical or post-transplant outcomes.
These can include:
Condition | Possible pre-transplant focus |
Diabetes | Improve glucose control |
Coronary artery disease | Assess and treat significant disease |
Kidney disease | Assess renal function and optimize management |
Liver disease | Determine severity and transplant implications |
Osteoporosis | Assess bone density and treatment needs |
Gastroesophageal reflux | Evaluate and manage reflux/aspiration risk |
Pulmonary hypertension | Optimize disease-specific treatment |
Sleep-disordered breathing | Review appropriate therapy |
Anemia | Identify and address the underlying cause |
Previous infections | Confirm appropriate treatment/control |
The ISHLT notes that comorbidities-including cardiovascular disease, renal dysfunction, osteoporosis, gastroesophageal reflux, diabetes and other conditions-can influence transplant risk and therefore require individualised assessment.
Lung transplantation can be emotionally demanding. Patients may experience uncertainty while waiting for a donor organ, concerns about surgery, changes in independence and anxiety about lifelong medications.
Psychosocial assessment is therefore a standard component of many transplant programs.
It may consider:
The ISHLT describes psychosocial assessment as an integral part of transplant evaluation because it helps identify support needs and potential barriers to successful post-transplant care.
Seeking psychological support is not a sign that someone is unsuitable for transplantation. In many cases, identifying challenges early allows the care team to provide appropriate support.
A lung transplant requires substantial involvement from patients and their caregivers after surgery.
Depending on the transplant centre, patients may need help with:
One should recognise adequate caregiving and social support as important components of successful transplantation and post-transplant adherence.
Before surgery, discuss who will provide support and what happens if the primary caregiver becomes unavailable.
Pre-surgery preparation should also include learning about the recovery period.
Patients should understand that transplantation does not mean that medical care ends after the operation. It begins a new phase of lifelong monitoring.
Post-transplant care commonly involves:
The American Lung Association notes that patients may need to remain close to the transplant centre after discharge, particularly when they do not live nearby, and emphasises continued medical follow-up and avoidance of respiratory infections.
Understanding these requirements before surgery can make the transition easier for both patients and caregivers.
Once a patient is actively waiting for a donor organ, preparation should include practical readiness.
A transplant go-bag can contain:
The American Lung Association specifically recommends keeping a prepared bag and practising the route to the transplant centre so patients and caregivers are ready when a donor call comes.
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Not every aspect of transplantation can be controlled. Donor availability, disease progression and medical urgency are important factors. However, several areas can be actively optimised.
Patients can actively work on | Transplant team manages |
Smoking cessation | Donor-organ allocation |
Medication adherence | Donor matching |
Rehabilitation participation | Surgical timing |
Nutrition | Organ acceptance |
Vaccination planning | Immunological compatibility |
Infection prevention | Intraoperative management |
Caregiver planning | Postoperative critical care |
Appointment attendance | Immunosuppression regimen |
Understanding transplant care | Long-term transplant monitoring |
This distinction can help patients focus their energy on areas where preparation can make a meaningful difference.
Preparing for a lung transplant involves comprehensive medical evaluation, infection screening, vaccination, rehabilitation, nutritional optimisation, and careful planning for surgery and recovery. For patients seeking treatment, MediGence can help simplify the journey by facilitating specialist consultations and second opinions, coordinating hospital and treatment arrangements, and supporting international patients with travel-related planning. While all clinical decisions remain with the treating transplant team, having coordinated support can help patients and their families navigate the medical and logistical aspects of lung transplantation with greater clarity and confidence.
There is no fixed timeline. Some patients undergo evaluation over several weeks, while others may require months to optimise their medical, nutritional or physical condition before listing or transplantation.
In many cases, yes. Pulmonary rehabilitation and individualised exercise are commonly recommended for transplant candidates. However, the intensity and type of exercise should be determined by the patient's pulmonary and transplant team.
Yes. Transplant programs generally require sustained abstinence from tobacco and nicotine products. Requirements and verification methods may vary between centres.
Immunosuppressive treatment after transplantation increases vulnerability to infections. Vaccinating before transplantation can provide an opportunity to develop better immune protection, and some vaccines cannot be administered after transplantation.
Both undernutrition and obesity can increase challenges associated with transplantation. Nutritional assessment allows the care team to address inadequate calorie or protein intake, excessive weight, muscle loss and nutritional deficiencies.
Alvina Hasan is a dedicated medical researcher and scientific writer with a strong foundation in the pharmaceutical sciences. She holds a B.Pharm from Jamia Hamdard University and an M.Pharm in Quality Assurance from DIPSAR University. With deep medical expertise and a strong interest in healthcare communication, she focuses on transforming complex clinical and scientific information into clear, engaging, and easy-to-understand narratives. She develops insightful healthcare articles and research-driven pieces designed to support both medical professionals and patients, helping bridge the gap between advanced medical knowledge and practical understanding.
Dr. Akash Khandelwal is a distinguished Haematologist, Hemato-oncologist, and Bone Marrow Transplant (BMT) Physician with extensive training from the prestigious AIIMS New Delhi. His expertise encompasses a wide range of specialized techniques in bone marrow transplantation, including autologous and allogeneic transplants such as matched sibling donors, matched unrelated donors (MUD), and haploidentical donor transplants. Dr. Khandelwal has personally supervised and conducted over 100 bone marrow transplants.
Delhi, India
Istanbul, Turkey
Istanbul, Turkey
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