ISHLT Response to OPTN Standardize Six-Minute Walk for Lung Allocation

Published 19 March 2024

• Advanced Lung Failure & Transplantation
• Cardiothoracic Surgery
• OPTN Comment

The International Society for Heart and Lung Transplantation (ISHLT) appreciates the opportunity to comment on the policy proposal “Standardize Six-Minute Walk for Lung Allocation.” This proposal aims to standardize the six-minute walk distance (6MWT) by requiring an oxygen titration test before the 6MWT. This will establish a patient's oxygen needs so that the test is performed on the amount of oxygen the patient requires to be ambulatory. We offer several comments for consideration before implementation:

1. Although the policy will improve data quality and equity amongst programs, it will lead to an increased burden on both patients and programs. In particular, patients who live far from the transplant center may require multiple visits to perform the titration test and the 6MWT because providers may not feel comfortable having the patient do serial 6MWTs in one day.
2. The proposal might benefit from more guidance on how this policy would be put in place for patients who are rapidly evaluated for transplant in the inpatient setting. Will multiple walk tests be required in the inpatient setting?
3. We would not recommend a prescribed time frame for repeating the titration test. One approach that may limit some of the burden is to only require repeat oxygen titration tests if oxygen needs at rest have changed.