10 Myths about Lung Transplantation
A/ Prof Daniel Chambers, Queensland Lung Transplant Service, The Prince Charles Hospital, BrisbaneMyth 1. I am a surgeon.
I am not – I’m a transplant physician! Everybody thinks that if I am talking about lung transplantation I must be a surgeon. Organ transplantation is one of the most complex medical treatments currently available and involves a large team of highly qualified medical (surgeons and physicians!), nursing and allied health staff. My job is to assess the suitability of a patient for transplantation, ensure no other, more readily available treatment options are available, and then look after them through the transplant process. On the night of transplantation the physician’s role is to decide who is the best match, manage the donor in partnership with Donate Life and manage the drug therapy required to prevent rejection and infection. Transplant physicians look after their patients forever, so the transplant clinic becomes like a big, very diverse, extended family. This diversity is one of the things I love about my job.
Myth 2. Lung Transplantation is an experimental treatment.
Lung transplantation was revolutionary when the first successful transplant was performed in Toronto in 1983, but it is now a well established treatment for selected patients with very advanced lung disease. Over 40,000 lung transplants have been performed worldwide.
Myth 3. You’re too old to have a transplant.
There is no doubt that lung transplantation is a high risk procedure, and age itself increases that risk, particularly after the age of 60. Most programs around the world will routinely accept patients up to the age of 65 years, with some patients who are otherwise in excellent shape accepted after the age of 65. However, by the age of 70 the risk of having a transplant has usually increased to such an extent that it becomes prohibitive. However, even in the 10 years I’ve been practicing transplantation, these figures have changed as our population ages and as people are healthier at an older age. There is no doubt that in the future, older patients who are in every respect ideal candidates other than for their date of birth, will be undergoing transplantation.
Myth 4. Lung transplants only last a short time, so they’re not worthwhile.
Prolonged survival following transplantation is now the norm, and most patients return to a full life including work, family, sport, hobbies, travel etc.
Myth 5. The heart is a more important and complex organ than the lungs.
Wrong – the lungs are not there just to provide a nice comfy nest for the heart so it doesn’t injure itself doing all its exciting beating! Of course you can’t live without either, but, compared to living with very poor lung function it is in fact easier to live without much heart function, with mechanical support, while waiting transplantation. The lungs are a much more complex organ because blood flow needs to be matched accurately to gas flow and at the same time the whole system needs to be protected from the outside world even though it has to be in direct contact so that air can get in. In contrast the heart is a relatively simple pump with no contact with the outside world. It is likely that artificial hearts constructed of biocompatible tissue will be a reality in the next decade or two, but similar artificial lungs are probably 30 years away because of the added complexity.
One thing that is special about heart transplantation is that I have met a number of heart recipients who feel as though a part of their personality has changed or they have a new talent which they attribute to the personality / talent of the donor. In contrast I have never met a lung transplant patient who feels similarly invigorated.
Myth 6. Women can’t have a baby after having a lung transplant.
It is true that it is difficult to fall pregnant and avoid miscarriage after having a lung transplant, and you need to be in very good health, but it is possible to carry a baby to the latter stages of pregnancy and deliver normally. In fact we hope to have a very exciting announcement quite soon…
Myth 7. You have to have your heart transplanted at the same time.
Until the early 1990s it was much more common to have a combined heart-lung transplant than a lung transplant, but now the reverse is true – only 2 or 3 heart-lung transplants are performed in Australia each year, while well over 100 lung transplants are performed. This approach now allows many more patients to be transplanted while not compromising outcomes.
Myth 8. Two lungs are way better than one.
It is true that over 10 years, a double-lung transplant is slightly better, but a single lung transplant is still an excellent treatment option, especially for those patients with idiopathic pulmonary fibrosis (IPF) where, due to the scarring nature of the disease and contraction of the chest wall, it can be very hard to find a suitable double lung donor. In this situation we can place a large single lung transplant, leaving the other diseased lung in place.
Myth 9. The sex of the donor needs to be the same as the sex of the recipient.
In fact sex mis-matching is not important in determining transplant outcome. In general however, males will be matched with males and females with females as it is crucial that we match the donor lung size with the recipient’s chest cavity size.
Myth 10. Romance is dead.
Let me tell you a beautiful story. Michael has cystic fibrosis and became rapidly ill last year – requiring ventilatory support to stay alive (Pic 1). All the while his devoted fiancé Zoe was by his side. Michael was listed for transplantation but time was running out. Fortunately for Michael the Queensland Lung Transplant Program acquired a new piece of technology called ex-vivo lung perfusion (EVLP) late in 2011. This machine allows us to retrieve donated organs like we normally would, but then gives us the option of resuscitating organs that are not immediately suitable for transplantation. What we do is place the organs on our EVLP machine, warm them back up to body temperature, ventilate them to mimic breathing and perfuse them with a special solution which removes toxins and excess fluid. Over a few hours we are able to restore near normal function to the lungs before testing them to make sure they are now safe to transplant. We have now performed 5 lung transplants using EVLP, including Michael’s. This technology allows us to use lungs that would never have been able to be used in the past and has no doubt saved Michael’s life.
Not long after Michael’s transplant he was so well that he was able to compete in the Bridge-to- Brisbane fun run (Pic 2) – note the acknowledgement to the XVIVO machine that saved his life on his t-shirt. Michael and Zoe’s love for each other rose above all of this drama – and I’m delighted to be able to say that they were recently married.
Pic 1: Michael in hospital before his transplant. He needed a ventilator mask (non-invasive ventilation (NIV)) to stay alive
Pic 2: Michael and Zoe after successfully completing the Bridge to Brisbane fun run