This Hospital Completes India’s First Double Lung Transplant During COVID-19 Pandemic

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What Is A Lung Transplant?

A lung transplant is a surgical procedure which involves replacing a diseased or failing lung with a healthy lung, usually from a deceased donor [1]. The transplant is reserved for people who have tried other medications or treatments but have not reported any improvements.

The survival rate for lung transplant patients has improved in recent years, in comparison to 20 years ago. However, the survival rates vary by facility, pointing out the need to ask about the facility’s survival rates [2].


Who Requires A Lung Transplant?

An unhealthy or damaged lung can make it difficult for your body to get the oxygen it needs to survive. Certain health conditions and diseases can damage your lungs and hinder their ability to function normally and virtually [3]. Conditions that can damage the lungs are as follows [4]:

Chronic obstructive pulmonary disease (COPD)

• Scarring of the lungs (pulmonary fibrosis)

• High blood pressure in the lungs (pulmonary hypertension)

• Cystic fibrosis

• Emphysema

• Sarcoidosis

In most cases, lung damage can be treated with medication or with special breathing devices [5]. In the event of these failing and posing a life-threatening risk, the individual will be directed to a transplant, where the doctor might suggest a single-lung transplant or a double-lung transplant.

A typical single-lung procedure can take between 4 and 8 hours. A double-lung transfer can take up to 12 hours [6]. In some cases, people with severe heart and lung conditions may need a combined heart-lung transplant.


What Are The Risks Involved In A Lung Transplant?

Lung transplant, being a major surgery involves certain risks. Some of the risks involved in a lung transplant are as follows [7]:

• Organ rejection, which happens when your immune system attacks your donor’s lung

• Serious complications can arise from immunosuppressants used to prevent rejection

• Immunosuppressants can raise your risk of infections, as your body has very low immunity [8]

• Bleeding and blood clots

• Cancer and malignancies due to immunosuppressants [9]

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• Kidney damage

• Stomach problems

• Thinning of bones (osteoporosis)

Therefore, in the case of the patient admitted in Apollo, the risks were extremely high due to the COVID-19 pandemic.


Successful Double Lung Transplant Amidst The COVID Pandemic

The double lung transplant during COVID times is an exemplary achievement. It has only been possible due to careful and cautious action from the group of doctors at the Apollo hospital, Chennai. The latest medical advances and technology has indeed contributed to the continued success of the surgery [10].

Dr T Sunder, Senior Consultant Cardiothoracic Heart and Lung Transplant Surgeon said, “Performing a transplant surgery during a pandemic presents many medical and logistic challenges to ensure the safety of recipients, family members and healthcare personnel. Safety is ensured safety via strict protocols that mandate all transplant patients to be received and managed only in dedicated areas that do not have any COVID patients.”

Speaking on the critical need to be extra cautious, due to the risk of infections, the surgeon continued, “The staff looking after them are assigned to only the transplant patients, and all are checked for COVID status. Post-operatively, all parameters of the recipients are passed on to the treating doctors in real-time via encrypted software and only if a physical examination is mandated is access to a patient given. A dedicated post-operative transplant care medical team does not cross over and examine other patients, further ensuring safety. Limiting physical contact with the recipient has been a feature of our transplant team since the inception of the transplant program.”


How Does ECMO Help With A Lung Transplant?

The successful transplant and recovery also bring into focus the success on the use of ECMO to support the heart and lungs until transplant or recovery. Recent technical improvements in ECMO have been able to expand the role of ECMO during lung transplantation [11]. Likewise, ECMO is a treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream [12].

The number of patients waiting for a lifesaving organ transplant far exceeds the number of available donor organs, and the need for organ transplants is increasing. When the patient condition deteriorates while waiting for a donor organ, ECMO, or Extra Corporeal Membrane Oxygenation comes to the rescue.

Similar to the heart-lung bypass machine used in open-heart surgery, the ECMO machine pumps and oxygenates a patient’s blood outside the body, giving rest to the heart and lungs. ECMO acts as a bridge to recovery and bridge to transplant.


On A Final Note…

The intricate surgery shines a light on the transformations in the medical field in the event of the new normal. With hospitals and authorities standing tall against the minacious pandemic, there is hope.

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