Physicians are applauding the changes in lung transplant practices resulting from new rules instituted last year. Fewer people are dying while waiting their turn for a donor lung, since those in most dire need are going to the top of the list.

Calling the transformation "amazing," Cynthis Herrington, a surgeon at the University of Minnesota Medical Center in Minneapolis, said "it's almost as if it's a whole new day for lung transplantation."

Rarely is it necessary anymore to obtain transplants from living people, a desperate measure that entails the risk of major surgery for two donors per patient, in most cases.

However, there is not yet evidence that overall survival rates for patients who receive lung transplants have changed -- it is still too soon to tell what impact, if any, the improvements in transplantation procedures are having.

Lung transplant candidates are typically patients whose lungs fail due to emphysema, cystic fibrosis or other lung diseases. Candidates must register in their regions to get on a nationally networked waiting list, as the demand for transplants far exceeds the supply of donor organs.

In the past, the lists operated on a "first come, first served" basis, without considering a patient's health status. Waiting times often exceeded two years. Patients who had diseases of sudden onset or rapid progression had to wait their turn, and often did not survive long enough to receive a donor organ.

The new rules, initiated in May of 2005, allow patients who are in imminent danger of death without a transplant -- but who would have a good chance of surviving with one -- to move to the top of the list.

In addition to the reprioritizing of patients, there has been another significant change: an increase in the supply of donor lungs. More people are deciding to become organ donors, and more lungs are being salvaged. Doctors have developed new techniques -- including the use of drugs and manipulation of respirator settings -- for keeping organs viable in patients who are brain-dead.

In Minnesota, for example, the number of lungs retrieved for transplants jumped from 25 to 97 in just one year, Herrington said.

Across the US, the number of lung transplants rose by 248 (to a total of 1,405 in 2005), and the number of people who died while waiting declined by 128 (to 360 in 2005).

Understandably, patients who have been waiting for years for a transplant may feel unfairly disadvantaged by a system that seems to require them to be at death's door before they can get a new lung.