Lung Transplantation

This policy covers lung transplantation for adults with chronic, end‑stage lung disease refractory to maximal medical or surgical therapy — including advanced interstitial lung disease, pulmonary hypertension, cystic fibrosis/bronchiectasis with severe FEV1 decline or recurrent exacerbations, rapid loss of lung function, or other life‑threatening pulmonary deterioration. Candidates must have an estimated >50% risk of death within two years without transplant and an estimated >80% likelihood of five‑year post‑transplant survival, be free of absolute contraindications (e.g., active malignancy, GFR <40 mL/min/1.73 m² unless multi‑organ transplant, uncontrolled infection, active substance use, inadequate adherence or severe comorbidity), and meet program‑specific requirements (Medicare members follow separate criteria and CF patients must have trialed eligible modulator therapy).

"Chronic, end-stage lung disease that has failed maximal medical therapy (including pulmonary rehabilitation, as applicable) or surgical therapy."