Dual lung transplants pick up pace over the last four years

Tamil Nadu has been performing a significant number of lung transplants, particularly dual lung transplants, in the last few years.

Despite being a “complex” organ to be transplanted, the utilisation of the donated lungs is slowly getting better in the State.

From three recipients in 2014, the number of recipients who underwent dual lung transplants went up to 28 in 2017 and 51 in 2018, according to data available with the Transplant Authority of India (Transtan).

“The last three years have seen a significant number of lung transplants, particularly dual lungs, being performed in the State. Less than 25% of lungs offered are utilised because lungs are the most susceptible to compromise in brain dead patients. We are having better organ utilisation in the last few years and the waiting period for patients is getting shorter,” said R. Kanthimathy, member secretary of the Transplant Authority of Tamil Nadu.

Early identification and rapid allocation process at Transtan has helped increase the number of lungs used, said Paul Ramesh, senior consultant, Cardiothoracic, Heart and Lung Transplant Surgeon, Apollo Hospitals. “However, the very fragile nature of lungs and significant damage to their function after brain death means that only 15-20% of lungs are usable not just in India but worldwide,” he added.

Sandeep Attawar, programme director and chair – Cardiac Sciences Thoracic Organ Transplants, Gleneagles Global Health City, said lungs were the most difficult organs to transplant and maintain considering that it was the only organ to be exposed to the fluid (circulation) in the body and external environment.

Standard of care

Dual lung transplants are recommended for any lung disease, he said, adding: “Dual lung transplants are the absolute standard of care. There is the same pathology in both lungs and choice of single lung transplant is restricted to patients who are very sick to undergo dual lung transplants, such as the elderly.”

Doctors said that lung function was better with dual lung transplants when compared to single lung transplant.

There are certain indications for doing combined heart and lung transplants. Dr. Ramesh observed that heart and lung are both physically and functionally extremely intertwined organ systems. “Hence, advanced diseases in one leads to dysfunction in the other. Development of irreversibly high lung pressures in advanced heart diseases and development of irretrievably damaged right heart in advanced lung disease are the two main reasons for combined heart and lung transplants and as such are high risk operations,” he explained.

RM. PL. Ramanathan, professor and medical director, PSG Lung Transplantation Programme, PSG Hospitals, Coimbatore, said interstitial lung disease was one of the important indications for lung transplants in the country. “In this, there is excess scar formation that shrinks the lungs as a whole, leading to progressive respiratory failure. This is followed by Chronic Obstructive Pulmonary Disease due to smoking. Post-tuberculosis bronchiectasis is another indication,” he explained.

It is the responsibility of the treating pulmonologists to identify the transplant window in patients with lung diseases, he said, adding: “Lungs are a complex organ to be transplanted. The timing of referral is important for better outcomes. They should identify the poor prognostic factor in patients with chronic lung diseases and refer them to a transplant centre.”

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