In this short presentation, pulmonologist Jeffrey A. Golden, MD, describes how the specialists of the UCSF Lung Transplant Program work together to ensure their patients are likely to succeed, with a focus on factors that can make or break survival prospects.
So my name's Jeff Golden G O L D E N and I'm a professor of medicine and surgery at UCSF. So how do we evaluate patients who come for lung transplant? First, the referring doctor sends the records. That that is actually the most important thing because you don't want to have the patient running all over the place if while going through the records there are obvious contraindications. That also is not necessarily perfect for guidelines because there's always people who have one coronary artery that's not normal that can be fixed before transplant. We make all these rules to see how we can get around them because we want to be fair, but. The records tell you a lot. For example, if somebody had a significant other malignancy within 5 years, we, we wouldn't have them come here. We break that rule all the time too. If somebody is well over 75 and if there's a way you can tell from the records there's an issue of the patient not being compliant, that is not following instructions. Well, that's, that's really a bad, a bad, uh, problem, and if there's not family support, you have to have some support. Not all supports family, but usually one of the two support people are, are a family member, and the other one might be. A neighbor or a church member or something like that, but you need to. We give a call and say, OK, come on, we'll, we'll see you, you're OK by the records, and then you really go through a new patient evaluation, which is actually something I like to do because they're not rushed, and then start the easy workup. The easy workup means just blood tests, and if everything seems fine and the social situation is fine. Then we uh do the more invasive tests, which we wouldn't do unless we were moving to transplant. And those invasive tests, mainly colonoscopy, but it's also cardiac catheterizations because we have to know if somebody is at risk for having a heart attack during surgery and all of the tests that you're familiar with, the non-invasive tests like treadmill and so forth, they're just not good enough. So we, we do an actual cardiac cath. And and another cath on the right side of the heart catheterization to see what certain pressures are and after that then they're presented to our surgeon and we have a selection every Tuesday and every Tuesday everybody with a new patient presents or patients who had questions about their patients present uh and then we go through it as a group and uh and there are disagreements and it's uh the disagreements are often. Related to very young people who have certain things that are hard to overcome technically as a surgeon, at the end of the day, we work, the internists work very well with the surgeon. My own prejudice is if there's something a surgeon finds worrisome, you know, that, that trumps everything else in terms of we like this patient, and that's the hardest situation to be in. Because you wanna do a specific patient. But usually, usually by the time we have the patients worked up, the surgeons know about them, then they hear everything at once. The heart's OK with the catheterizations.
