From Doing The First Lung Transplant in India, What has Changed Over A Decade?

Dr. Jnanesh Thacker from Yashoda Hospitals Hyderabad shares his experience

“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.” Said Dr. Jnanesh Thacker, Program & Surgical Director – Heart, Lung, Heart & Lung Transplantation & Assist Devices, Yashoda Hospitals Hyderabad.

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 catalyzed 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 the 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 the blood.  

Surgical progress

Not only Medical but Surgical advancements have occurred in the last decade, for instance, the introduction of Extracorporeal oxygenation membrane (Artificial Lung). It helps in maintaining oxygenation when the transplanted Lungs are recovering from an injury, or when the patient’s breathing collapses (i.e. Lung failure).

Hospitals have access to a better preservative solution to preserve the donated Lung with a new solution called Perfedex (a Dextran based solution, a substance that 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 100 years. With the advance in surgical techniques, surgeons can tailor the lung to fit the size of the chest cavity. Hence, this has led to the usage of a stapler made of Titanium in triple rows of varying depth for better preservation of the blood supply to the cut-edges of the Lungs. The recent advance of Double-Lung transplantation has shown improved 5-year survival since before the last decade around the early 2000s surgeons were replacing only single lungs for fibrotic diseases. But today, Double Lung Transplants patients can survive beyond 5 years with great ease.

Recovery rate progress

The recovery rate is accelerated by better surgical techniques and better postoperative care which is prevalent only in the current decade. All the medical and surgical advances have led to better, faster 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.”

The 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. Extracorporeal 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.

What needs to change to perform more Lung Transplants in the future?

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 continues to remain high for Lungs as compared to other solid organ transplants. Challenges about 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 by creating awareness amongst the citizens of the nation by allowing 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.