Audience: (Please share this notice with anyone in your organization who would benefit from it.)
- Lung and heart-lung transplant programs
- Data Coordinator, Quality Coordinator, TX Program Administrator/Manager, TX Program – Clinical Coordinator, TX Program Director, Primary Program Administrator, TX Fellow, Medicine, TX Fellow, Surgery, TX Physician-Additional,TX Physician Assistant, TX Physician-Other, TX Surgeon-Additional, TX Surgeon-Other, Compliance Officer, TX Nurse, Primary Physician, Primary Surgeon, Primary Data Coordinator, Primary Program Administrator, Primary Clinical Consultant, Clinical Leader
- OPTN Lung Transplantation Committee
Implementation date
Sept. 3, 2024
At-a-glance
A new policy requirement is in effect that requires lung transplant programs to perform an oxygen titration test ahead of the six-minute walk test for lung candidates at least 12 years old or who are about to turn 12 years old. This policy change promotes equity in lung priority by standardizing the six-minute walk test for lung allocation. Please see “Additional details” below for expanded information, including answers to frequently asked questions.
What lung transplant programs need to do
- For lung transplant candidates registered prior to Sept. 3, 2024, who are at least 11 years 6 months old on Sept. 3, 2024:
- Complete an oxygen titration test prior to conducting the six-minute walk test for reporting a six-minute walk distance by March 3, 2025
- Document the final amount of supplement oxygen from the oxygen titration test in the candidate’s medical record
- For lung transplant candidates registered after Sept. 3, 2024:
- Complete an oxygen titration test ahead of the initial six-minute walk test for lung candidates at least 12 years old
- Complete an oxygen titration test for the six-minute walk test conducted just before candidates turn 12 years old
- Document the final amount of supplement oxygen from the oxygen titration test in the candidate’s medical record
In addition, update any internal policies regarding oxygen titration and the six-minute walk to align with policy changes and coordinate with their pulmonary function testing laboratories to schedule additional tests for lung candidates.
Additional details
Below are answers to a number of anticipated questions about the updated policy and new or changed requirements:
How should the six-minute walk test be conducted?
- Per the approved guidance, transplant programs are advised to follow the 2002 American Thoracic Society Guidelines for the Six-Minute Walk Test and the 2014 European Respiratory Society/American Thoracic Society technical standard on field walking tests in chronic respiratory disease to the extent possible
- If the six-minute walk distance is measured in meters, Appendix A of the guidance may be used to convert the walk distance from meters to feet
How should the oxygen titration test be conducted?
- An example oxygen titration protocol is provided in the guidance (see page 15)
When should the oxygen titration test be performed relative to the six-minute walk test?
- Per the approved guidance, transplant programs are advised to perform the oxygen titration test as close in time ahead of the six-minute walk test as is feasible but no more than 12 weeks prior to the six-minute walk test
What if a lung candidate is unable to complete the six-minute walk test?
- Per the approved guidance, if a candidate is unable to safely perform the six-minute walk test, then the test should not be performed, and the lung transplant program should report a walk distance of zero (0) feet for the candidate
- However, lung transplant programs are advised to avoid entering a walk distance of 0 feet and to administer the six-minute walk test if it is deemed safe for a candidate to attempt the test, even if the candidate is not expected to walk far or is not expected to walk the full six minutes
- If the six-minute walk distance value is missing or expired, then the composite allocation score calculation will:
- Substitute a value of 4,000 ft to calculate the waiting list survival score per OPTN Policy 21.2.A Values Used in the Calculation of Lung Waiting List Survival
- Substitute a value of 200 ft to calculate the post-transplant outcomes score per OPTN Policy 21.2.B.1 Coefficients Used in Calculating Lung Post-Transplant Outcomes
- When a lung candidate is unable to complete the six-minute walk due to reasons unrelated to their lung disease severity (e.g., lower limb amputation, joint necrosis, etc.), the lung transplant program should report a walk distance of zero (0) feet for the candidate. The transplant program may submit an exception request for the post-transplant outcomes component of the candidate’s lung composite allocation score
Education and resources
- For more information, read the OPTN policy notice
- New guidance and an updated OPTN Member Evaluation plan is available OPTN website
- Updated help documentation for six-minute walk distance is available in the OPTN Waiting List
