Author: ETHealthworld l February 03, 2020 l Image Source: Britannica
AIIMS, which pioneered heart transplants in India, has now decided to conduct lung transplants too — making it the first hospital in the capital and the second public institution in the country to offer the procedure after PGIMER, Chandigarh.
AIIMS had recently applied for a licence to conduct the life-saving surgery, which the health ministry granted. The institute is now screening potential candidates — patients with chronic, end-stage lung disease for whom no effective medical therapy exists — to prepare a waiting list.
Dr Anant Mohan, professor and head of pulmonary medicine at AIIMS, said one patient had been selected for the surgery a few weeks ago but he died before the transplant could be carried out. “We are preparing a list of two to three other potential candidates,” he added.
Lung transplant, like a heart transplant, can only be carried out with organ donated by a deceased donor. Till date, only about 4,000 such transplants have been done globally, including about 200 in India.
All lung transplants in India, except for one, have been performed at private hospitals where the procedure can cost Rs 20-30 lakh or more. Follow-up medications, which have to be taken lifelong, cost several lakhs a year.
AIIMS director Dr Randeep Guleria said the institute will not only conduct the transplant free of cost, but will also provide the follow-up medicines at no cost.
A lung transplant is a surgical procedure to remove one or both diseased lungs from a patient and replace it with a healthy one from a cadaver donor. The world’s first lung transplant was conducted in human in 1963 in the US. But due to high rejection rate and healing issues, fewer transplants could be conducted in the decades to come.
Some doctors in the US have also attempted living donor lung transplants, where a part of the lung from the donor is transplanted, but the results haven’t been encouraging yet.
Between 1999 and 2011, records show, five foreigners underwent lung transplants in various hospitals in south India.
In 2012, a 41-year-old woman from Mumbai became the first Indian to undergo the life-saving surgery. She was suffering from pulmonary fibrosis, in which lung tissue gets scarred and breathing becomes difficult.
Dr A G K Gokhale, chief cardiothoracic and transplant surgeon at Apollo Chennai said with rising lifeexpectancy and increase in lung diseases, the demand for lung transplant has gone up.
“The availability of high-end antibiotics and improved surgical techniques has raised the success rate of the surgery but there aren’t enough cadaver donors. Also, the cost of surgery as well as post-operative care are high and out of reach for many,” he added.
Another doctor, who has led several lung transplant surgeries down south, said states like Telangana have come up with new rules banning the policy of giving organs retrieved from cadaver donors to foreigners. “This has also led to significant reduction in such transplants because not many people can afford the postoperative care,” he said.
The survival rate among recipients of lung transplant in India is much less as compared to that in the US, doctors said.
Public sector hospital PGIMER Chandigarh recently conducted a lung transplant on a 33-year-old woman. The surgery was successful but the patient developed a multi-drug resistant infection post-transplant which led to her death in 14 days.
According to Dr A K Bisoi, who was part of the team led by Dr P Venugopal that conducted India’s first heart transplant in 1994, technical feasibility isn’t the most difficult part when it comes to conducting a heart or lung transplant.
“The tough part is to arrange suitable cadaver donors. Also, most patients in a country like ours cannot afford post-transplant care, which involves taking immunosuppressive medications daily and living in a sanitised environment to reduce the risk of infections,” he said.
To deal with the shortage of cadaver donors, some scientists are also working to develop an artificial lung that’s small enough to be carried in a backpack.
Currently, such patients are dependent on large machines such as extra corporeal membrane oxygenation (ECMO) for breathing support.
According to reports, University of Pittsburgh and Carnegie Mellon University in Pittsburgh have conducted animal trials for the artificial lung developed by them and, the researchers say, human trials will be done soon.