Outcomes of lung transplant candidates referred for co-management by palliative care: A retrospective case series

Palliat Med. 2015 May;29(5):429-35. doi: 10.1177/0269216314566839. Epub 2015 Jan 29.


Background: Lung transplant candidates experience important symptoms, but they are rarely referred for palliative care consultation until they are deemed ineligible for transplant. Our lung transplant service has a high rate of palliative care referral for patients awaiting transplant.

Aim: We reviewed the characteristics, interventions, and outcomes of lung transplant candidates referred for co-management by palliative care, to determine whether they safely received opioids and went on to transplantation.

Design and participants: Retrospective review of lung transplant candidates referred to our palliative care consultation service between January 2010 and May 2012.

Results: Of 308 lung transplant candidates, 64 (20.7%) were referred to palliative care. Most had interstitial lung disease and were referred for dyspnea and a rapidly deteriorating course. A total of 59 (92%) were prescribed opioids for dyspnea, 55/59 used the opioids more than once, and 38/59 were maintained on standing opioids. There were no episodes of clinically important opioid toxicity or respiratory depression, and there was a trend toward increased exertion during exercise sessions post-opioid versus pre-opioid (19.3 vs 17.0 kcal, respectively, p = 0.06). At last follow-up, 30 (47%) had been transplanted, 23 (36%) had died while on the wait-list, 9 (14%) had died after delisting, and 2 (3%) were still awaiting transplantation. Of the 30 patients who underwent lung transplantation, only 7 (23%) still required an opioid prescription 1 month post-discharge.

Conclusion: In lung transplant candidates, palliative care and opioids in particular can be safely provided without compromising eligibility for transplantation. Palliative care should not be delayed until a patient is deemed ineligible for transplant.

Keywords: Organ transplantation; analgesics; chronic obstructive; cystic fibrosis; hypertension; interstitial; lung diseases; opioid; palliative care; pulmonary; pulmonary disease.

MeSH terms

  • Adult
  • Aged
  • Analgesics, Opioid / therapeutic use
  • Disease Management
  • Dyspnea / drug therapy
  • Dyspnea / etiology
  • Female
  • Hospital Mortality
  • Humans
  • Lung Diseases / complications
  • Lung Diseases / mortality
  • Lung Diseases / therapy*
  • Lung Transplantation / statistics & numerical data*
  • Male
  • Middle Aged
  • Ontario / epidemiology
  • Palliative Care / statistics & numerical data*
  • Retrospective Studies


  • Analgesics, Opioid