The highest volume program in the nation, the Duke Lung Transplant Program (DLTP) sees such success in part because of a rigorous preparation program for transplant patients. Until fall 2025, patients awaiting transplant had to stay within two hours of Duke, requiring many patients to relocate. DLTP now offers qualifying patients a “stable waiting from home pathway” to transplant for those living within driving distance of Duke.

“We’re modifying our pre-transplant program to strike the balance between being sensitive to patients’ finances while also maintaining a high standard of physical conditioning so they can achieve the outcomes post-transplant they’re looking for,” says transplant pulmonologist John M. Reynolds, MD, DLTP medical director.

“We looked at the barriers to transplant,” says transplant pulmonologist Laurie D. Snyder, MD, MHS, DLTP associate medical director. “The costs of relocating and removing patients from home social support systems were significant.” Snyder notes that improved perfusion technology also allows for flexibility in surgical timing, another factor that widens the potential area for patients to wait.

Duke is one of the few programs to invest in physician licensure in multiple states to offer telehealth visits for DLTP patients, including all states contiguous with North Carolina to enable remote evaluation and monitoring.

Before transplant, all patients come to Duke for a medical evaluation and multidisciplinary patient education and rehabilitation program to prepare recipients and caregivers for the surgery and recovery. Although more than 75% of Duke lung transplant patients receive transplants within 30 days, some patients face longer wait times due to blood type, antibody matching challenges and/or the presentation of their lung disease.

After the initial evaluation and rehabilitation period, patients may now be eligible to continue their pre-transplant physical therapy program at home if they meet all of these criteria:

• medically stable
• using under 12 liters of supplemental oxygen per minute
• have a place to exercise with adequate oxygen support

The Duke team monitors these patients’ exercise and condition with daily check-ins via an app, weekly phone calls, and monthly in-clinic appointments.

The first patients in the pathway have done well, says Rebecca Byrd, DPT, clinical operations supervisor for pulmonary rehabilitation services, who helped to develop the option. “Our patients who’ve been in the program at least one month have maintained their exercise capacity or even made gains from home,” Byrd states. “We hope this option can expand access to more patients who may not have been referred in the past.”

“Initial feedback from patients in this pathway now is highly positive,” Snyder agrees. “They really appreciate being at home while still having a close connection with the program.” Patients in the pathway have already begun to receive transplants with the same excellent outcomes as patients who relocated.

The updates are just one way Duke is constantly innovating to help as many patients as possible. Recently, the DLTP performed nine transplants in seven days, a record for the program, with all patients doing well.

“We continue to be a leader in lung transplant by numbers as well as in research and innovation,” Snyder says. “Referring providers don’t have to screen for eligibility — we are happy to evaluate all patients and determine if they’re candidates for this program.”