I am currently on a Lung Transplant rotation, and this past week I got to have a once-in-a-lifetime experience of traveling with the team to procure a set of lungs for one of our patients. This is unlike any other rotation I’ve had so far. The medications, the management, and basically everything else is all new to me. So I had no idea what to expect when we found out we had a set of lungs.
Lung transplant all starts with the “listing” of a patient. We see patients from all over who suffer from diseases such as Cystic Fibrosis, COPD, Pulmonary Fibrosis, and lots of interstitial lung diseases, such as asbestosis, berylliosis, etc. Before a patient can go on the transplant list, they have to go through a battery of tests, ranging from a heart catheterization to a psychiatric evaluation.
After all the tests are completed the patient is discussed at a weekly meeting, attended by all the pulmonologists, the psychiatrist, the transplant coordinators, the surgeons, and everyone else involved. Our center is particularly aggressive, so many patients who wouldn’t be considered good candidates at other centers get lucky when they come to us. Some of the most common reasons for being excluded from the list include BMI, age, muscle weakness, and poor rehab potential.
If the team agrees, a patient will be put on the transplant list. If the team decides the patient is not a good candidate or wouldn’t benefit from a transplant, then the patient has to get the unfortunate news. I had the opportunity to be in the room when one of our patients found out he was not going to be listed. I can’t imagine how hard that is to hear. Lung transplant is usually a last resort for patients, so not being listed is often a death sentence.
For patients who are put on the list, the wait begins. Since our center is more aggressive, wait times are less. Some patients only have to wait weeks, while some might wait for months. Offers come in and centers are given the choice to take or reject the offer. If one center rejects, the next center can jump in. If our center thinks the lungs are a good match for our patient, we let them know and then they get the choice to take the lungs or not. Sometimes lungs come from “high risk” donors who may have had a history of IV drug use or something, and a patient might not want those lungs.
If everyone agrees, the wheels are set in motion. Our center has a number of physicians who “procure” lungs for us. We have to find one who is available to go out on a procurement. We also need a nurse and transportation to and from wherever the lungs are.
In the case I witnessed, the lungs were in another state. So two surgeons, a nurse, and myself hopped in a small private plane and made our way to the lungs. There were a lot of delays when we got there, so it took a few hours before we could begin, but once everything was ready, we set to work.
The hardest part of procuring lungs, at least from my perspective, was the fact that we weren’t just getting some lungs. We were getting the lungs from someone who was brain dead. I’ve never seen a brain dead person before. And honestly, he/she looked just like every other surgical patient I’ve ever seen. Before we began the procedure, we had a “time-out,” which is a short pause for all the nurses and surgeons to make sure the right procedure is being done on the right patient. However, this time-out was different. We had a brief moment of silence, and a short statement from the patient’s family was read. It was so touching, I had a hard time not breaking into tears.
Organ donation is just such an amazing gift. The patient’s family must be so distraught, yet in such a difficult time, they still found the strength to give something back – something that would save a complete stranger’s life. I hope that they know how much that means to the patient on the other end.
After the time-out, we started the surgery. Our team was there to get the lungs, as well as another team to get the liver and kidneys. So there were a ton of people in the room. Usually, there would be even another team there to get the heart, however no one had accepted this heart, so it was going to be used for research. The surgery took just a few hours. I was in complete awe the entire time. To see human anatomy in a living patient is so different than I learned with my cadaver back in anatomy lab. I saw a human heart still beating and lungs still breathing. I was able to hold the heart in my hand as soon as it was removed. Without a doubt, it was one of the coolest things I’ve ever done in my life.
After the lungs were out, we wrapped them up, put them on ice, and placed them in our Igloo cooler. Then we flew back to Arizona to put them into our patient who was already waiting in surgery. It was a very long process, but I feel so blessed to have been a part of it. Every day when I see our transplant patient, I just keep thinking, “I’ve seen those lungs! I know exactly where those came from!”