Insights from Dr. Gerard Criner, Temple Lung Center

Lung transplantation remains one of the most complex, resource-intensive interventions in pulmonary medicine, requiring precise coordination across disciplines, rapid evaluation pathways, and long-term patient management strategies.

Dr. Gerard Criner, Director of the Temple Lung Center, recently joined the Becker’s Hospital Review podcast to share practical insights on how high-performing programs scale responsibly - while maintaining a focus on outcomes, access, and innovation.

Program Growth & Infrastructure

Q: What has driven the growth of high-volume lung transplant programs?

Program growth is not driven by transplant alone - it is the result of a comprehensive advanced lung disease ecosystem.

Patients referred for transplant typically have exhausted medical and non-transplant therapies, present with complex conditions, or continue to decline despite advanced interventions

A high-volume program must therefore:

• Serve as a destination for advanced therapies, not just transplant
• Maintain a robust referral pipeline through non-transplant care offerings
• Deliver multidisciplinary, coordinated care across the continuum

Q: What does the infrastructure of a high-performing transplant program look like?

Lung transplantation is fundamentally a team-based model, requiring tight integration across:

• Pulmonary & critical care medicine
• Thoracic surgery
• Anesthesia & OR teams
• ICU and inpatient care teams
• Advanced practice providers
• Rehabilitation specialists
• Pharmacists and psychologists
• Diagnostic teams (PFT, imaging, pathology)
• Operational and environmental staff

Programs must also be built to handle:

• Variable surgical volume (periods of low activity followed by surge days with multiple transplants)
• 24/7 readiness for urgent procedures
• Concurrent care for dozens of post-transplant patients at any given time

At any one time, we have about 40 transplant patients in the hospital. There might be a day or two when no transplants are done, then a day when two or three need to happen. You have to be able to handle the surge.

Q: How are leading programs optimizing evaluation and time-to-transplant?

Speed and coordination are critical, particularly for high-acuity patients.

Best practices include:

• Rapid inpatient evaluations: within 3–5 days
• Outpatient evaluations: typically within 2–3 weeks
• Multidisciplinary review committees: within 2–3 weeks of evaluation
• Efficient listing pathways aligned with allocation scoring systems

Based on CAS score and other factors, about half of our patients are transplanted within two months.

Q: What is the most underestimated challenge when scaling a transplant program?

One of the most overlooked challenges is organizational alignment across the entire health system and coordinated support for tangential staff such as lab and pathology services, transport teams, environmental services, diagnostic technicians - just to name a few. A successful transplant program should prioritize staff engagement and support across all roles and foster a culture where every contributor understands their impact on outcomes.

Further, a “transplant-only” model is not sustainable. Programs must offer comprehensive advanced lung disease care, including non-transplant therapies and provide solutions for patients who are not transplant candidates or are not yet ready for transplant in order to maintain continuity of care across the disease trajectory. 

This approach:

• Improves patient outcomes
• Strengthens referral relationships
• Builds a sustainable clinical pipeline

Q: How should programs balance growth with quality?

Volume alone is not the goal - long-term outcomes are the primary measure of success for any transplant program.

While higher volume can contribute to greater procedural experience and improved recognition of clinical nuances the priority remains: durable, long-term patient outcomes and continuous program refinement based on experience. At the end of the day, it’s the quality that matters, not the quantity. 

What are the key investments required to sustain quality at scale?

As programs grow, they must invest in structured longitudinal care models, including:

• Dedicated post-transplant care pathways
• Systems to manage large cohorts of long-term survivors
• Continuous monitoring protocols

Once you’re caring for 1,200, 1,500 or 1,800 surviving transplant patients, you need structured programs to maximize their outcomes.

A critical focus area is Chronic Lung Allograft Dysfunction (CLAD). Long-term management, particularly for CLAD, is often as important as the transplant itself.

Effective programs need to detect early signs through proactive monitoring, be able to adjust therapies in real time, and integrate clinical research to improve long-term outcomes.

How does academic medicine drive progress in transplant and advanced lung disease care?

Academic programs play a central role by advancing evidence-based care models, participating in and leading clinical research and trials, and translating innovation into real-world practice.  

This includes:

• Developing new therapies
• Refining patient selection criteria
• Improving long-term management strategies

Academic medicine remains essential to advancing care and improving survival.

Q: What guiding philosophy should leaders adopt when scaling programs?

A good physician treats a disease. A great physician treats the patient. Lung transplant programs must be built on comprehensive advanced lung care, not transplant alone, and to achieve this, multidisciplinary coordination and an infrastructure that establishes that foundation are critical to success.

Q: What is the future of advanced lung disease management?

The long-term goal is not simply to expand transplant capacity, but to reduce the need for transplant altogether.

This will depend on continued investment in research and innovation, earlier intervention in disease progression, and the development of therapies that alter disease trajectory.

Q: What would you consider a key takeaway for any physician managing patients with advanced lung disease?

Pulmonologists managing patients with advanced lung disease play a critical role in ensuring timely access to specialized care.

Early referral to an advanced lung disease and transplant center can expand treatment options, optimize patient condition prior to intervention, and improve long-term outcomes.

Partner With Temple

Temple’s team works closely with referring physicians to ensure timely access and clear communication throughout the referral, evaluation, and post-transplant phases.