Lung Transplant In Gurgaon and Delhi, India

A lung transplant is a surgical procedure to replace a diseased or failing lung with a healthy lung, usually from a deceased donor. A lung transplant is reserved for people who have tried medications or other treatments, but their conditions haven't sufficiently improved.

Depending on the medical condition, a lung transplant may involve replacing one of your lungs or both of them. In some situations, the lungs may be transplanted along with a donor heart.

While a lung transplant is a major operation that can involve many complications, it can greatly improve your health and quality of life.

History

Attempts at lung transplantation have occurred as early as 1946 when Vladimir Demikhov, a Soviet scientist, attempted single-lung transplantation in a dog. This transplant ultimately failed from bronchial anastomotic dehiscence, and difficulties with this anastomosis would plague clinical lung transplantation for the next 40 years. Henri Metras, in 1950, reported the first successful dog lung transplant and the first bronchial artery and left atrial anastomoses. In a nonhuman primate model, performed lung reimplantation and showed that these lungs were able to maintain function postoperatively, despite denervation. On June 11, 1963, reported the first human lung transplant; however, the patient died from kidney failure after 18 d. The first real survivor during this early era of lung transplantation was a patient of Fritz Derom’s in Belgium.This patient, however, survived only 10 mo. The failure of this early experience in clinical lung transplantation can be summarized by inadequate immunosuppression and difficulties with the bronchial anastomosis.

The advent of cyclosporine brought about significant improvements in patient survival following liver and kidney transplantation. This led to a resurgence of interest in heart/lung transplantation in Stanford and lung transplantation in Toronto. The first successful combined heart–lung transplant was completed by Reitz and colleagues and showed that a grafted lung could survive and function in a recipient. Research performed by Cooper’s group in Toronto showed that corticosteroid use appeared to be a significant factor in the weakness of the bronchial anastomosis. With the use of cyclosporine, corticosteroid use could be reduced, leading to improved bronchial healing. In 1986, the Toronto Lung Transplant Program reported the first successful single-lung transplantations for two patients with pulmonary fibrosis. This team went on to perform the first successful double-lung transplant, first with an en bloc technique that used a tracheal anastomosis, then evolving to the bilateral sequential transplantation technique that not only improved airway healing, but also had the additional benefit of avoiding cardiopulmonary bypass, if desired. This technique remains the standard technique in use to this day.

Indication

Lung transplantation is indicated for patients with chronic, end-stage lung disease who are failing maximal medical therapy, or for whom no effective medical therapy exists. General indications include:

• Untreatable end-stage pulmonary disease of any etiology
• Substantial limitation of daily activities
• Limited life expectancy
• Ambulatory patient with rehabilitation potential
• Acceptable nutritional status
• Satisfactory psychosocial profile and emotional support system

Some of the diseases that may require a lung transplant among this population include:

• Chronic obstructive pulmonary disease (COPD)
• Cystic fibrosis and bronchiectasis for other causes
• Idiopathic pulmonary fibrosis and non-specific interstitial pneumonia
• Pulmonary hypertension
• Sarcoidosis
• Lymphangioleiomyomatosis
• Bronchoalveolar carcinoma
• Re-transplant bronchiolitis obliterans
• Bronchopulmonary dysplasia or chronic lung disease
• Heart disease or heart defects affecting the lungs

Types of transplant

There are 3 main types of lung transplant:

A single lung transplant – where a single damaged lung is removed from the recipient and replaced with a lung from the donor; this is often used to treat pulmonary fibrosis, but it's not suitable for people with cystic fibrosis because infection will spread from the remaining lung to the donated lung.

A double lung transplant – where both lungs are removed and replaced with 2 donated lungs; this is usually the main treatment option for people with cystic fibrosis or COPD.

A heart-lung transplant – where the heart and both lungs are removed and replaced with a donated heart and lungs; this is often recommended for people with severe pulmonary hypertension. The demand for lung transplants is far greater than the available supply of donated lungs. This means a transplant will only be carried out if it's thought there's a relatively good chance of it being successful.

Where Do Lungs Come From

Most lungs that are transplanted come from deceased organ donors. This type of transplant is called a cadaveric transplant. Healthy, nonsmoking adults who are a good match may be able to donate part of one of their lungs. The part of the lung is called a lobe. This type of transplant is called a living transplant. People who donate a lung lobe can live healthy lives with the remaining lungs.

1.Cadeveric Donors

Donation After Brain Dead

Brain death is a state of cessation of cerebral function wherein the proximate cause is known and is considered irreversible. The American Association of Neurology (AAN) has defined brain death with three cardinal signs, cessation of the functions of the brain including the brainstem, coma or unresponsiveness and apnea.

In India, the Transplantation of Human Organ Bill was introduced in the Lok Sabha on 20th August 1992 and became the Transplantation of Human Organ Act in 1994. The limited availability of organs amidst a growing demand emphasizes the need for optimal donor care. There is no global consensus in the criteria for establishing brain death, and significant differences exist in the tests used. In many countries, including India, the diagnosis of brain death is made after fulfilling the mandatory criteria and by the apnea testing which is a safe technique for documentation.

A brain-dead organ donor needs the same intensity of care with the focus of treatment directed toward organ perfusion and improved quality of grafts. Intensive care with the use of invasive lines is mandatory for improved quality of care and titration of inotropes and fluids.

A potential donor is one who is brain-dead or one with catastrophic brain injury with a clearly expressed intent from the physician and the family to withdraw life support. The organ procurement organization recently has adopted a “presumptive strategy” in counseling wherein grief counselors communicate with the family with the presumption that organ donation is the natural thing to be done and act both in the interests of the potential donor as well as the pool of recipients.

Donation After Cardiac Death

Donation after Circulatory Death (DCD), previously referred to as donation after cardiac death or non-heartbeating organ donation, refers to the retrieval of organs for the purpose of transplantation from patients whose death is diagnosed and confirmed using cardio-respiratory criteria.

There are two principal types of DCD, controlled and uncontrolled. Uncontrolled DCD refers to organ retrieval after a cardiac arrest that is unexpected and from which the patient cannot or should not be resuscitated.

In contrast, controlled DCD takes place after death which follows the planned withdrawal of life-sustaining treatments that have been considered to be of no overall benefit to a critically ill patient on ICU or in the Emergency Department.

2. Living Related Donor

It's possible for a person to receive a lung transplant from living donors. During this type of lung transplant, the lower lobe of the right lung is removed from 1 donor and the lower lobe of the left lung is removed from the other donor. Both lungs are removed from the recipient and replaced with the lung implants from the donors in a single operation.

Living-donor lobar lung transplantation (LDLLT) has become an important life-saving option for patients with severe respiratory disorders, since it was developed by a group in the University of Southern California in 1993 and introduced in Japan in 1998 in order to address the current severe shortage of brain-dead donor organs. Although LDLLT candidates were basically limited to critically ill patients who would require hospitalization, the long-term use of steroids, and/or mechanical respiratory support prior to transplantation, LDLLT provided good post-transplant outcomes, comparable to brain-dead donor lung transplantation in the early and late phases. In Kyoto University, the 5- and 10-year survival rates after LDLLT were reported to be 79.0% and 64.6%, respectively. LDLLT should be performed under appropriate circumstances, considering the inherent risk to the living donor.

What is the procedure for lung transplant?

After some tests and qualifying criteria, you will be put on the waitlist for donor lungs. Waiting time depends on various factors like geographical distance between donor and recipient, blood group, availability of matching lungs , your overall health and severity of lung condition.

When lungs are available, you will be notified and instructed to reach the hospital immediately where you are registered for lung transplant.

Now we will see what procedure you can expect in lung transplant.

• First of all you will receive an IV and general anesthesia. Because of that, you will be in induced sleep.
• Then the surgical team will insert a tube in your windpipe to help you breathe, another tub will be inserted in your nose to empty your stomach and a catheter will be inserted to keep the bladder empty.
• You may also be put on a heart lung machine to pump your blood and oxygenate the blood during the surgery.
• After all these preparations, the surgeon will make a large incision on your chest. Your old lung will be removed after incision.
• After removal of your old lung , the new lung will be connected to your blood vessels and main airway.
• Then the incision will be closed after surgeons are satisfied that the new lung has started working properly.
• Single lung transplant can take 4 to 8 hours long surgery while double lung transplant can take 12 hour long surgery.
• After this process you will be shifted to ICU for a few days.
• In the ICU your body will be closely monitored for a few days and you may expect to go home after some weeks, depending on the speed of your recovery.
• Then for the next 3 months, the lung transplant team will closely monitor any signs of rejection, infection in the lungs.
• You may be given immunosuppressants from preventing your body from attacking new lungs.