Eliminating Gaps in Lung Transplantation in India

A lung transplant is usually recommended for people who have lung diseases that have progressed significantly or continue to progress rapidly despite optimal medical treatment

The COVID-19 pandemic has brought lung-related issues to the fore as the virus primarily affects the lungs. However, India suffers from massive exposure to respiratory diseases. In severe stages, these can lead to pulmonary fibrosis or scarring of the lungs, which can dramatically affect the patient’s life and quality of life. Up to 15 percent of patients with Covid developed a moderate and up to 5 percent severe form of the lung disease.

Many of them may have chronic lung conditions that require continuous external oxygen support. In selected patients with significant lung involvement, a lung transplant may be the only glimmer of hope. A lung transplant is a procedure that involves the transplantation of a section or lobe of the lung, an entire lung, or both lungs of a person who has a seriously ill or failing lung. In recent years, lung transplantation has become the standard of care for people suffering from end-stage lung disease and has been shown to give good quality to patients with no hope for years.

Recently, a Japanese woman whose lungs were severely damaged by COVID-19 became the world’s first recipient of a lung transplant from a living donor.

A lung transplant is usually recommended for people who have lung diseases that have progressed significantly or continue to progress rapidly despite optimal medical treatment. Such conditions include COPD, bronchiectasis, interstitial lung disease, severe pulmonary hypertension, cystic lung disease, etc. People with chronic lung disease have a progressive condition that turns them into oxygen dependent overtime with reduced mobility and poor quality of life.

These patients require more attention and care from a dedicated team trained in dealing with these patient populations. These patients also have poor appetites resulting in nutritional deficiencies and need nutritional support from a dedicated nutritionist. Pulmonary rehabilitation helps and trains these people to stay healthy overall with mobility.

It is one of the most complex organ transplants, requires specialized expertise and compliance with the correct selection protocol of the donor lung and assessment of the patient’s health. Lung transplants are not suitable for all patients, and each patient must be evaluated on a case-by-case basis to determine whether or not a lung transplant is suitable for them.

It is often offered as a last resort when other treatment measures such as medication or breathing equipment stop working. Some isolated cases also require a heart-lung transplant, a rare procedure in which both the patient’s heart and lungs have extensive irreversible damage and must be replaced in order to improve their quality of life and survival.

Lung transplant procedures typically depend on the availability of deceased donor lungs. Finding the right match for organ transplant is of the utmost importance for successful surgery. Various factors such as blood group, sizing, age, patient health and other health conditions, tissue type, pulmonary function tests, etc. must be considered before a patient is considered suitable for a lung transplant.

The process of procuring an organ itself is an elaborate process that includes multiple subject areas and coordination between different centers and organizations. Not only has there been an increased need for lung transplants over the past year, the process of facilitating organ donation has evolved and improved, increasing the number of needy patients receiving much-needed lung transplants. Organ transplantation often gives new life to the patients who receive it, and the noble act of organ donation, whether dead or alive, needs to be encouraged and supported.

Support from insurance companies and crowdfunding can help patients gain access to much-needed lung transplants. Donor organ rejection is one of the greatest challenges and risks in organ transplants, and so is lung transplantation. After the lung transplant, patients must take lifelong immunosuppressive medication and use prophylaxis to prevent secondary infections. As the level of immunosuppression is gradually reduced, the risk of secondary infection also decreases.

Lung transplantation in India is still in its early stages with very few medical facilities and trained doctors available for this type of surgery. A comprehensive team that includes all specialties under one roof is the order of the day to solve the problems with these patients who are ill and have multiple comorbidities.

Dr. Pavan Yadav, Consultant – Interventional Pulmonology, Sleep Medicine and Lung Transplantation, Aster Hospitals Bengaluru

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