Table 4 Developed rules for referral investigation

The initial level of decision

General criteria for patient referral

Age: if (age > = 65 and age > = 14) then “patient has age criteria” and age = true

ESLD:1- Is the patient in the end stage of lung disease? -> ESLD = True

2- Does the patient have less than a 50% chance of surviving? -> Probability = True

3- Does the patient have advanced lung disease despite the optimal treatment? -> Advanced = True

The second level of patient evaluation for referral to the LTx center

Determine and investigate the NYHA class

Has the patient had no symptoms in his physical activity with no limitations? -> if yes, NYHA = Class I

Has the patient had mild symptoms only in normal activity? -> if yes, NYHA = Class II

Has the patient symptoms during daily activity, and is asymptomatic only during rest? -> if yes, NYHA = Class III

Has the patient severe limitation symptoms even in rest? -> if yes, NYHA = Class IV

The third level of patient evaluation for referral to the LTx center

Confirm disease diagnosis

Are the tests and history of disease verified diagnosis? -> DX = True

Does his/her disease include the permitted disease in our center? -> Disease = True

The fourth level of evaluation is related to a patient referral to the ltx center

Investigate the criteria based on the disease

If we assume that the patient has COPD:

If (FEV1 > 35%) -> FEV1 = True

If the patient has a history of severe dyspnea? -> Dyspnea = True

If the patient has a history of recurrent hospitalization? -> Hosp = True

If (NYHA class = 3 OR NYHA class = 4) -> NYHA = True

If (FEV1 = True AND Dyspnea = True AND Hosp = True AND NYHA = True) -> The patient has the criteria of referral