Awareness vital on lung transplants

A 23-year-old youth was desperate to get relief from his long standing breathing difficulty. He was barely able to walk a few yards and struggled for each breath, while his friends ran, laughed and played without any conscious effort. He was diagnosed with ‘idiopathic pulmonary arterial hypertension’, a condition of unknown cause where there is increased pressure in the blood circulation to the lungs.

His suffering was not relieved despite the best available medical management by various renowned centres across the country. He was seen by the team of pulmonologists at the Narayana Health City and was given the option of lung transplant. Unfortunately, he lost his life before he could decide regarding the transplant.

This is not just the story of one young man; thousands of people of all ages are victims of this terrible condition. Were we too late? Could we have saved him? Not every disease can be cured, but the real question is ‘can we do something to save valuable young lives who can make a difference to this world, or should we accept their fate and let these people succumb?’

The least we can do is make an extra effort to decrease the suffering and give them a reasonable chance of survival and of leading a normal life. Lung transplant is one of the promising options in such conditions.  What does lung transplant do?

• Lung transplant offers a potential treatment option for highly selected patients with advanced chronic lung disease and who continue to progress despite maximal medical therapy. Since 1963, when the first lung transplant was done, more than 49,000 transplants have been performed worldwide till date.

Even though India started performing lung transplant in 1999, it has never reached its expected peak and the programme is still at a very nascent stage. So far, only around 150 lung transplants have been done across the country, despite the fact that we have a huge burden of respiratory diseases.

• In lung transplantation, the lungs (either one or both) are taken from a deceased organ donor and transplanted into the recipient, within a narrow window of six hours after they are harvested. The recipient is first assessed for suitability to receive the donor lungs and receives immunosuppression before and lifelong after the procedure.

Regular follow-up is needed with close monitoring for both rejection and infection. The lung is a fairly active organ in the immune process, so fairly intensive immunosuppression is needed to ensure that the recipient’s immune system does not reject the transplanted lung/s. As the lungs are potentially exposed to infective organisms through the air we breathe, the immune-suppressed recipient is always at risk of various infections.

• Lung transplantation is sadly lagging behind all other organ transplants drastically, probably because it depends almost exclusively on cadaveric donation, the exorbitant expenses associated with transplants and the challenging post operative management. Poor donation rates and the high prevalence of infections such as tuberculosis, which can complicate post operative management also act as obstacles to a successful lung transplant programme.

• Fibrotic lung diseases, chronic obstructive pulmonary disease (COPD) and cystic lung disease are common respiratory diseases which usually progress despite best medical management. These diseases not only increase the risk of death, but also pose a substantial economic burden — both individually and to the country. So there is a definite need for us to think about considering lung transplantation in such conditions, especially among the youth.

• Sustaining a lung transplant programme is a big challenge due to the lack of awareness, both among the doctors and the patients. Initially, we have to work on creating awareness ab­out the availability of the transplant option. Doctors also need to be aware of when to refer the patient to the transplant listing centre. Additionally, we need to increase our donation rates by encouraging more people to sign up for organ donation after death. There are many who are in need of transplants but unfor­tunately die waiting for an organ.

According to the United Network for Organ Sharing, an organisation coordinating organ donations and allocation in the United States, which has a significantly better donation rate than India, about 21 people die every day waiting for transplant and every 10 minutes someone is added to the transplant list.

• The need of the hour is to encourage the programme despite the challenges and get the programme rolling.

(Dr Tousheed is Junior Consultant and Dr Mohan is Senior Consultant & HoD, Department of Pulmonology, Narayana Health City, Bengaluru)