In general, when patients are getting worse despite medical therapy, and there seem to not be other options available, it is a reasonable time to at least consider lung transplant. As a transplant physician, I would rather evaluate someone too soon (and if the patient is too healthy for transplant, hold off on listing and just follow them over time in the event that they worsen) rather than too late in the disease (when it becomes more difficult to try to address any medical or other problems that increase a patient’s risk for transplant). Earlier evaluation allows the patient and family to learn more about transplant from the center, and address any concerns that may arise in the evaluation process.