Kasim Shariff, a retired central government employee from Bengaluru was 65 when he was diagnosed with Idiopathic Interstitial Pneumonias in 2015. Shariff, who was leading a happy post-retirement life, suddenly saw his health take a nosedive. He spent years in and out of hospitals, fighting to stay afloat. His doctors unanimously declared that the only solution for his end-stage lung disease was lung transplant surgery.
“Idiopathic interstitial pneumonias (IIPs) is a type of interstitial lung disease (ILD) that causes fibrosis or scarring of lungs, hindering gas exchange,” says Dr Basha J Khan, senior consultant, Pulmonology, Mazumdar Shaw Medical Center, Bengaluru, one of the doctors who treated Kasim. Dr Khan says that it has no known cause and can be progressive.
“My health deteriorated rapidly. I experienced wheezing, breathing difficulties and medications did not help. Soon, I resorted to occasional oxygen support. Two years post my diagnosis, I was on 24×7 oxygen support,” recalls Kasim.
Eventually, Kasim became wheelchair-bound, with no strength to perform everyday activities. He had repeated infections and was in the ICU every fortnight.
According to Dr Khan, once a person has advanced lung disease and cannot function without oxygen support, they may need a lung transplant.
What is a lung transplant?
“Lung transplant is a procedure where a damaged lung is replaced by a healthy lung, usually from a brain-dead donor,” says Dr Julius Punnen, senior consultant cardiac surgeon, Heart & Lung Transplant, Mechanical Circulatory Support, Narayana Institute of cardiac sciences, Bengaluru, who also treated Kasim.
“When a condition causes the lungs to fail (end-stage lung disease), and the damage can’t be reversed with medicines, a transplant is a final resort,” says Dr Punnen.
Dr Punnen says that in end-stage lung disease, a person undergoes respiratory failure and cannot breathe on their own. They will need oxygen support even when resting, can barely walk and tend to be bedridden.
Shedding light on the various conditions that can progress into requiring a lung transplant, Dr Nandkishore Kapadia, Head – Adult Cardiac Surgery & Director, Heart & Lung Transplant Service, Kokilaben Dhirubhai Ambani Hospital Mumbai mentions Chronic Obstructive Pulmonary Disease (COPD) and ILDs.
Dr Punnen mentions conditions like pulmonary hypertension (high blood pressure in the arteries of the lungs and heart), bronchiectasis (abnormal widening of the airways of the lungs causing mucus build-up) and lung infections.
Types of lung transplant
Dr Kapadia lists the different types.
-
Single lung transplant
A single damaged lung is replaced by a healthy lung from a cadaver or brain-dead donor. Single lung transplants are less common and may be done when the chest cavity is too damaged for a double lung transplant. Conditions like pulmonary fibrosis can be managed with single lung transplant.
-
Double lung transplant
Both lungs are replaced with the donor’s lungs. Most lung transplants are double lung transplants, where the lungs are procured from a brain-dead donor. In conditions like pulmonary hypertension and bronchiectasis, a double lung transplant is deemed suitable.
-
Living-donor lobar lung transplantation (LDLLT)
According to a study published in The Journal of Heart and Lung Transplantation, LDLLT was developed as an alternative therapy for critically ill persons, including children who would not survive the waiting period for deceased-donor lung transplantation.
Multiple living donors, usually close relatives like parents or siblings, donate a portion of their lung. In children, one lobe from each parent is usually taken to be reconstructed as a full lung.
-
Heart-lung transplant
If the person has end-stage heart and lung disease, they receive a heart and a pair of lungs from the same donor.
When Kasim was undergoing tests before his surgery, he was diagnosed with coronary artery disease, entailing a heart-lung transplant.
Finding the right donor
The new year of 2019 greeted Kasim with a new life. Within two and a half months of being enlisted for transplant, Kasim found a suitable donor in a 24-year-old man who was declared brain-dead after a road accident.
“Not all donated lungs are suitable for transplantation and only a quarter of them meet the criteria for transplantation,” says Dr Punnen.
He adds that the organ should be devoid of infections or trauma and the lung function should be optimal. The blood group and antigen-antibody complexes of the donor and recipient should be compatible. The lungs should be approximately the same size.
“A large lung can be made smaller to some extent, but a smaller lung cannot be made larger. Sometimes, the lung is so large for the recipient that it cannot be accommodated into their chest cavity, which is a fixed size,” says Dr Punnen.
Life after lung transplantation
Dr Kapadia says that one must take life-long medications called immunosuppressants, to prevent organ rejection.
“Wear masks to avoid infections. Follow-ups with tests like bronchoscopy and biopsy are done to ensure that there is no organ rejection,” says Dr Kapadia.
Kasim, now 73, has made rapid strides in his health. While the initial months post the transplant was bumpy with weakness, weight loss and frequent hospitalisations, things gradually became better.
“From being wheelchair bound, I can now ride my motorbike, travel to the market to run errands or go for walks,” beams Kasim.
Takeaways
A lung transplant is often a last resort for people with end stage lung disease, where they undergo respiratory failure and are unable to breathe without oxygen support. There are different types of lung transplant, but a double lung transplant is most common.
