Lungs are a pair of organs present in the chest and their function is to help us breathe. From every breath of air that we take in, the lungs extract the oxygen and eliminate the carbon dioxide from the body. The diseases that affect the lungs can impair their ability to do this function.
When lung failure results in lack of oxygen in the body it causes breathlessness. It is one of the most uncomfortable sensations to experience. The patients suffering from lung diseases will eventually require the support of extra oxygen for survival. They will become limited in their ability to do work. Minimal exertion results in exhaustion and leaves them breathless. The levels of oxygen in the body can drop dangerously low that can cause heart attack, stroke or cardiac arrest. In more severe situations, the patients will need to be on continuous oxygen support even while resting on bed.
Pulmonary fibrosis, pulmonary hypertension and chronic obstructive lung disease (COPD) are the most common conditions that can cause lung failure. These diseases are progressive in nature and can eventually lead to severe disability and death. Unfortunately medications offer only modest benefit and are not very effective in slowing down the disease progress. In such situations, Transplantation of the lungs from brain dead donors have made a big impact in the life of patients suffering from end stage lung diseases. The quality of life improves with better tolerance of day to day activities without breathlessness and oxygen support. After successful lung transplantation, people can resume their regular activities without limitation, return to work and even enjoy their favorite hobbies. The life expectancy also improves compared to the dismal prognosis of pulmonary fibrosis and pulmonary hypertension.
The first successful lung transplantation was performed in 1983 in Canada. It was a single lung transplantation done for a patient with pulmonary fibrosis. The first combined Heart-Lung transplantation was done in Stanford hospital, USA for a patient with pulmonary hypertension in 1981. Currently about 2000 lung transplants are being performed annually in United States. The most common reason for needing a lung transplantation are pulmonary fibrosis, COPD, pulmonary hypertension, congenital heart disease and bronchiectasis. What initially started as an experimental procedure is now an established standard of care in patients with end stage lung disease.
Before proceeding to lung transplantation the patients are evaluated to check for their fitness to undergo the operation safely. It involves a comprehensive assessment to ensure that organs are properly functioning. Lung transplant is a major surgery with its associated risk for complication and death. Hence the transplantation should ideally be done during the “Safe window for transplant” – The period during which the patient has an advanced failure of the lung but not so severely compromised physical fitness and nutritional status. It should not be done too early in the course of the disease or too late that the patient has less chance of surviving an operation. It is a procedure with potential for greatest satisfaction and benefit to both the patient and the health care providers as it really brings the patient out from the jaws of death back to normal life with ‘New Breath’.
Dr. Suresh Manickavel
Consultant Pulmonologist and Heart-Lung Transplant Physician
Apollo Hospitals, Greams Road, Chennai.