On a bright sunny March day, Amie Gray walked out of the University of Alberta hospital and into history, as Alberta’s first living donor lung transplant (LDT) recipient; only the 4th in Canada.
Before the transplant, the 22 year-old Lloydminister, Alberta, woman, with Cystic fibrosis, could barely do a slow ten-minute walk, with the help of oxygen, on the hospital treadmill; two months later she was doing a brisk half hour each day.
“I have more energy than ever,” says Gray. “I’m looking forward to doing things for myself again, going back to work and going to school.”
Gray had been on the transplant list for ten months and her condition was rapidly deteriorating. “For every week she was out of hospital, she spent two weeks in,” notes Dr. John Mullen the cardiothoracic surgeon who performed the eight-hour, three patient operation. “We had trouble even keeping her weight up, she was struggling for her every breath”.
About twenty per cent of patients waiting for lung transplants die each year. In British Columbia, the wait is 15.7 months, in Manitoba it’s around two years, in the U.S., it’s two to three years. Mullen felt Gray had six months or less to live.
“We’d planned to do this procedure for a long time, even before the first ones were done in Winnipeg,” notes Mullen, a clinical associate professor and director of cardiac surgery. “Gray was exactly what we were looking for; small, with at least three ABO compatible donors.”
Only the lower lobe of the lung is transplanted, so to compensate for the size of the lung, the recipient must be around 20 percent smaller than the donor. Grey’s small stature made her father Herman Gray, 46 and her friend Richard Behnke, 26 perfect donors.
For a donor the procedure is similar to a Lobectomy, for lung cancer. It carries a one per cent chance of mortality and leaves the donor with a minimal reduction in lung capacity.
But it is major surgery . “Given the risks to the donor, this is an operation of last resort,” notes Dr. Helmut Unruh, director of the Manitoba Lung Transplant Program and head of the team, which performed Canada’s other three LDTs. “If there were enough cadaver donors, there would be no need for living donors.”
The Canadian government will spend 20 million dollars over the next five years to pump up Canada’s dismal organ and tissue donation rate. The Canadian Counsel for Donation and Transplantation will be housed in Edmonton, Alberta and chaired by Dr. Philip Belitsky of Dalhousie University. Through awareness programs and a countrywide system to coordinate donations, they hope to raise Canada’s donation rate, presently 13.7 donors per million population. (The U.S. rate is 22.5, Spain 32.)
Transplanting only part of the lung is more complicated; there is a 10 per cent chance of death from postoperative complications in the first month. But because the donor is often a relative, there is less chance of rejection.
The transplant is not a cure, but because Gray survived the first month without any complications, Mullen feels she has an 80 per cent chance of living five years. He hopes the lungs last her 10 or 15 years.
LDTs are becoming commonplace in some US hospitals. The University of Southern California’s (USC) University hospital has done 110 since doing the first double LDT in 1993. Dr. Vaughn Starnes, a Hastings professor and chairman of cardiothoracic surgery at USC, did the first single LDT on a 12-year-old girl at Stanford University Medical Centre, in 1990.
USC boasts an adult one-year survival rate of 72 per cent, for children it’s 80 per cent. Two of their patients have survived eight years.
Dr. Adel Giaid, a professor of medicine at McGill University in Montreal, Quebec, has been studying the effects of detraction on cadaver lungs. Using animal models, his team tested lungs from brain dead cadavers, as well as from non-heart-beating cadavers. The second group had their lungs chilled and preserved soon after death, while still in the body. After two hours, they found the chilled lungs from the non-heart-beating cadavers were just as suitable for transplantation as the lungs from brain dead cadavers.
At the University of Lund, in Sweden, doctors recently transplanted a lung from a Cardiac Arrest patient into a 54-year-woman with Chronic obstructive pulmonary disease. The lung is functioning well.
Doctors hope this procedure will someday become standard practice, greatly expanding the donor pool.
According to the United Network for Organ Sharing, there are almost 4,000 Americans waiting for lungs, only 926 lung transplants were done in the U.S. in 1999, but 500,000 people die of Congestive Heart Failure in the US alone, each year.