COPD is the third leading cause of death globally, and remains the most common reason for lung transplantation worldwide. There are several key differences and considerations between COPD and other lung diseases that may be referred for lung transplantation.

Patients with COPD have a progression of disease over a long period of time and this makes it difficult to know when to refer a patient for transplantation. Patients with COPD have less short-term mortality, putting them lower on the list for transplant allocation. There is a longer transplant window for patients with COPD, but this can be a positive factor or a negative one since patients may develop more deconditioning and experience other health setbacks over time. Assessing the quality of life a patient with COPD may be having would seem like an important factor to consider, but there is some debate whether quality of life should be considered in transplant allocation. Currently, the lung allocation score does not factor in quality of life considerations.

Another important consideration is survival benefit. The median survival after lung transplant is 6.7 years. Even for patients with severe COPD, this time may be shorter than the expected survival without transplant. The slow progression of COPD can make it difficult to determine a survival benefit.

Many factors need to be considered when referring for lung transplantation, especially in patients with COPD. Patients should discuss their desire for transplantation with their pulmonary physician and, if desired, seek a referral for evaluation at a transplant center.