Despite the challenges posed during these COVID-19 times, MGM Healthcare, a multi-specialty quaternary care hospital in the heart of the city, became the third hospital in the world to announce the successful completion of a critical bilaterallung transplant on a COVID-19 positive patient. This is Asia’s first known lung transplant on a COVID-19 positive patient and the second lung transplant in the hospital since the lockdown began. The transplant was led by Dr. K. R. Balakrishnan, Chairman & Director of Cardiac Sciences and Director of the Heart and Lung Transplant Program at MGM Healthcare, and his team of transplant specialists including Dr. Suresh Rao, Dr. Srinath and Dr Apar Jindal.

The transplant was performed on a 48 year oldgentleman from Delhi, who was suffering from severe lung infection with COVID-19. His lungs were severely damaged due to COVID-19 related fibrosis. He developed COVID infection on 8^th June 2020.  Only a small portion of the lungs was still functioning. As he became breathless and oxygen saturation came down he was put on ventilatory support on 20^th June 2020.  His condition continued to be worsening inspite of ventilator support, he was airlifted to MGM Healthcare from Ghaziabad on 20^th July 2020.  His lung condition continued to be worsening in spite of maximum ventilatory supportive care, and he was put on ECMO support on 25^th July 2020 for more than one month. Such patients are difficult to manage even in well-equipped ICUs.

Commenting on the procedure, Dr. K. R. Balakrishnan said, “We were initially in a dilemma when his case was referred to us. But as doctors, we are taught to prioritise the patient’s overall health over anything else. Keeping this in mind, we decided to proceed with the surgery. Here I would like to commend and thank my team of doctors and the other support staff for taking up the challenge and boldly standing by the decision to go ahead with the transplant, without thinking about the risk to their own health and safety. We are happy for the patient as the transplanted lungs are working well.”

According to Dr. Suresh Rao, Co-Director, Institute of Heart & Lung Transplant and Mechanical Circulatory Support, “as the patient’s both transplanted lungs were working well, we removed the ECMO support.  Now his clinical condition is stable.  At the same time, we accepted the heart from the same donor to another patient who was waiting for a heart transplant, thereby giving a new lease of life to two people”.

Commenting on the patient’s condition, Dr. Apar Jindal, Clinical Director & Consultant, Lung Transplant, Interventional Pulmonology & Chest Medicine said, “Those select patients suffering from COVID pneumonia where all medications and mechanical ventilators fail to show positive results, an early initiation of ECMO support may be a lifesaving modality.  Over time, progression can determine whether the patient improves spontaneously or may be offered the option of lung transplant.  Lung transplant may well be the answer to many of the COVID survivors whose lungs are healing with fibrosis and making them a chronic respiratory cripple.”

“While the lockdown and the phased unlocks are a much-needed moves to limit the community’s chance of exposure to the Coronavirus, MGM believes that health caring must go on. The good news from a healthcare perspective is that despite the travel restrictions imposed by the Government, both at the centre and State levels, medical contingency travel was never a problem if a patient and close family members followed the procedures laid down. It’s indeed a proud moment for MGM Healthcare…the long distance travel that the patient and his family decided to undertake despite the limitations is testimony to our expertise when it comes to transplants. I would also like to take this opportunity to thank everyone who played a role in ensuring that hereached us at the earliest for the next treatment steps to be expedited,” adds Dr. Prashanth Rajagopalan, Director, MGM Healthcare.

The transplant was performed on August 27, 2020. Post the transplant, the patient is doing fine in the Transplant ICU at MGM Healthcare.

Also read : LUNG TRANSPLANT- A RAY OF HOPE

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Respiratory illness are one among the biggest killers around the world. They stand 2nd, in causing death in India, next to accidents. Respiratory illness is responsible for sufferings and they are also pose a huge burden on economy of the nation.

The depiction is overwhelming if the younger people or the earning family members are affected with these chaos. Thousands of people from all age group are sufferers of these dreadful conditions such as chronic obstructive pulmonary disease (COPD), fibrotic lung illness, bronchiectasis (a type of fibrocystic lung disease), or idiopathic pulmonary artery hypertension.

Cataloguing patients with these diseases used to be like announcing a death sentence, as they progress relentlessly with time in spite of getting the best existing medical treatment. Auspiciously, this is no longer true, developing technology as lung transplantation has revolutionized the treatment of chronic respiratory diseases. Despite the fact that India has made its remarkable achievements in other organ transplant, lung transplant is yet in its childhood. India, even though facing a largest burden of respiratory disease, is padding far behind in its lung transplant programme. India has done less than 200 lung transplants so far, whereas over 50 thousand lung transplants have been performed around the world.

How does lung transplantation help?

Lung transplant is a ray of hope for damaged patient.

1. Lung transplantation provides a probable treatment option for extremely selected patients with advanced chronic lung disease who persist to get worse in spite of maximal medical therapy. Patients who are unable to do perform their regular work, and are hardly able to walk and are reliant on oxygen therapy for a long duration are the patient who can take the advantage of transplant.

2. In lung transplantation, the lungs (either one or both) are taken from a dead organ donor and transplanted into the recipient. The recipient is primarily assessed thoroughly for suitability of transplant  and if appropriate donor is accessible, transplant is done within a narrow window of 6 hours after they are collected.

3. The lung is an active organ in the immune process, so moderately intensive immunosuppression is essential to make sure that the receivers immune system does not refuse the transplanted lung/s. As a consequence the receiver is probably exposed to infective organisms through the air we breathe.

4. Lung transplant not only require medical expert but also require incredible support and dedication. Despite the fact that it’s a big challenge to begin lung transplant program and is going to be a challenging to sustain in the existing conditions especially India. Narayana Hrudayalaya has taken this massive footstep to aid patients suffering from persistently progressive lung disease and have no treatment modalities.

Dr Syed Z Tousheed, Dr Basha J Khan, Dr BV Murali Mohan
Lung Transplant Physicians
Narayana Health City , Bangalore

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