From first lung transplant in India to current challenges: What has changed over a decade?

Lung transplantation is the definitive treatment for end-stage Lung disease but it took several decades of experimental studies and clinical attempts to reach this success, writes Dr Jnanesh Thacker

About Author: Dr Jnanesh Thacker, Program & Surgical Director – Heart, Lung, Heart & Lung Transplantation & Assist Devices, Yashoda Hospitals Hyderabad. Dr Thacker is the first surgeon to operate on the first Indian patient in India who got a Lung Transplanted in India, in Mumbai in 2012. He was also the first in India to do a successful minimally invasive Lung Transplantation in 2013. He is also the first surgeon to operate for a successful Lung Transplantation (Double) in a teaching Hospital in India.

Jayshree Mehta, a 41 year old homemaker from Vile Parle, Mumbai was the first Indian to get the First Lung Transplant in India successfully on 11th July 2012, and this surgery was done by Dr. Jnanesh Thacker, also known as the Pioneer of Lung Transplantation in India. This event served as a catalyst to begin the development of Lung Transplantation programs in the country. Back then, the primary challenge was that there were very few organ donations. In Mumbai in the year 2008, there were only 31 donations in the preceding 15 years, whereas in Tamilnadu there were 496 donations in last 5 years, which is 16 times more in comparison to Mumbai and any other State in India.
In 2008 The British Medical Journal carried a caricature column wherein a doctor while advising a patient said, ‘You need a Kidney transplant? Go to Madras, it is the kidney market of the world’. And thus began an outrage amidst senior officials of the government in Tamilnadu. In a 3-day conference with all healthcare administrators and decision makers for Transplants, the government addressed the need for a robust Cadaver Transplant Program. Furthermore, the government of Tamilnadu issued 8 government orders (GO’s) to boost this program. Due to the transparent and equitable distribution of organs, the state managed to increase their Transplants manifold.
What has changed for Lung Transplantations in the last decade?
Medical progress
Several advancements have taken place to make Lung transplantation a safe operation for patients with end-stage Lung disease. Medical interventions with progressive improvement in anti-rejection medication have enabled physicians and surgeons to ensure an uncomplicated recovery post-surgery. Better intensive care monitoring technology, such as Cardiac output monitor which measures the amount of blood pumped by the heart; Pulse oximeter aids to have better methods to measure oxygen implants; advanced blood gas machines to measure oxygen, carbon-dioxide, acid and alkalinity of blood.
Surgical progress
Not only Medical but Surgical advancements have occurred in the last decade, for instance the introduction of Extra corporeal oxygenation membrane (Artificial Lung). It helps in maintaining oxygenation when the transplanted Lungs are recovering from an injury, or when the patients breathing collapses (i.e. Lung failure).
Hospitals have access to better preservative solution to preserve the donated Lung with a new solution called Perfedex (a Dextran based solution, a substance which has higher osmotic pressure i.e. higher concentration solution).
Technology progress
There has been an improvement in the quality of sutures like polypropylene which can remain inert without causing any reaction in the body for duration of 100 years. With advance in surgical techniques surgeons are able to tailor the lung to fit the size of the chest cavity. Hence, this has led to the usage of stapler made of Titanium in triple rows of varying depth for better preservation of the blood supply to the cut-edges of the Lungs. Recent advance of Double-Lung transplantation has shown improved 5-year survival, since prior to the last decade around the early 2000’s surgeons were replacing only single lungs for fibrotic diseases. But today, Double Lung Transplants patients are able to survive beyond 5 years with great ease.
Recovery rate progress
Recovery rate is accelerated by better surgical techniques, and better post-operative care which is prevalent only in the current decade. All the medical and surgical advances have led to better, faster and speedier recovery for patients who receive Lung Transplantations.
Survival without a Lung Transplant
Dr. Jnanesh Thacker explains, “Most patients coming to me ask me if they can be managed medically instead of having a Lung Transplant. The fact is that these patients with End-stage Lung disease have only 10% chance of being alive for 1 year as compared to 10% chance of being alive for 20 years with a Lung Transplant operation.”
Emergence of Air Ambulance for Lung Transplants
In the COVID era the spotlight has shifted to the urgent need for Lung Transplants and ECMO i.e. Extra corporeal membrane oxygenation (Artificial Lung). There are a few Lung Transplant programs in the country, which are mainly limited to Maharashtra, Tamilnadu and Telangana. Hence, patients from different geographies in India are airlifted and transported to these Lung Transplant centres. Similarly organs also need to be transferred from different locations to these centres for successful Lung Transplantations. This burden has increased and the need of the hour is to have chartered planes and helicopters for such Transplant emergencies.
Way forward
The field of Lung Transplantation has made several significant advances in the last 9 years, ever since the first Lung Transplant in India on an Indian patient in 2012. Despite these advancements, the morbidity and mortality rate continue to remain high for Lungs as compared to other solid organ transplants. Challenges pertaining to donor shortage continue to prevail and must be prioritised, which requires people education to accept organ donation as a norm, and this can take place with creating awareness amongst the citizens of the nation by allow organ life beyond death. Organ awareness programs must be introduced in communities, religious institutions, schools, colleges, and all associations of the lay and the learned. Such changes within our society will deem to have a significant impact on shaping the field of Lung Transplantation in the post-Covid era.

**The views expressed by author are his own.