In a year when Covid-19 crushed the pleas of so many people who prayed for miracles, a Georgia man with two new lungs is one of the lucky ones.
Mark Buchanan, from Roopville, had a double lung transplant in October, almost three months after Covid-19 left him in hospital and anesthetized him, first in a ventilator and then in the last resort, known as ECMO.
“They said it ruined my lungs,” Buchanan, 53, said. “The exhaust and the covid completely destroyed them.”
Full coverage of coronavirus outbreak
At the time, only a handful of U.S. hospitals were willing to take a chance on organ transplants to treat the sickest Covid-19 patients. Too little was known about the risks of the virus and the lasting damage it could cause, let alone whether such patients would be able to survive the operation. According to his wife, Melissa, Buchanan was turned down at Emory University Hospital in Atlanta. Doctors advised her to withdraw treatment and allow him to die peacefully.
“They told me to end his life. I absolutely did not tell them, “remember Melissa Buchanan (49).” We all started googling anywhere anyone would need a lung transplant. “
I expect this to be a whole new category of transplant patients.
It rang to several hospitals, plus a favor from a doctor in his hometown, before Buchanan was accepted to the University of Florida Health Shands Hospital, 350 miles away in Gainesville, Florida. He received his new lungs on October 28th.
Almost six months later, the transplant landscape changed drastically. Covid-19 transplants are on the rise as hospitals struggle with a growing subgroup of patients whose organs – mostly hearts and lungs – are basically destroyed by the virus, “said Dr. Jonathan Orens, an expert in lung transplantation. Johns Hopkins University School, said.Medicine in Baltimore.
Nearly 60 transplants were performed until March 31 for patients with Covid-19-related organ disease, according to figures released Monday by the United Network for Organ Sharing, which oversees transplants in the US. It contains at least 54 lung and four heart transplants recorded since then. new codes for Covid-19-specific diagnoses were adopted in late October. One patient received a combination heart-lung transplant. Another 26 patients eligible for Covid-19 lung transplants and one eligible for a heart transplant remain on waiting lists, UNOS data show.
Nearly two dozen hospitals performed the surgeries, with new sites every month.
“You see it moving around the country, and it’s moving pretty fast,” said Dr. David Weill, former director of the Stanford University Medical Center’s Lung and Heart Lung Transplant Program, who now works as a consultant. ‘It’s like a wildfire, where centers say,’ We did our first one, too. ”
The boom in transplants is largely fueled by the wide range of the virus. As U.S. cases with more than 560,000 deaths account for the largest number in the U.S., there are thousands of patients who have survived particularly serious infections, with severely damaged organs that pose life-threatening complications.
“I think this is just the beginning,” said Dr. Tae Song, surgical director of the lung transplant program at the University of Chicago, said. “I expect this to be a whole new category of transplant patients.”
Tens of thousands of patients whose organs were otherwise healthy developed serious, chronic lung disease after contracting Covid-19. Because it’s a new disease, it’s not yet exactly how many people need the transplant, Weill said. He called on the development of a lung transplant registry to track the results.
So far, the increase in Covid-19-related transplants has not dramatically affected the existing waiting lists for organs. Of the more than 107,000 patients on waiting lists, about 3,500 require hearts and more than 1,000 lungs. Most of the rest are waiting for kidney transplants, which have not been significantly increased due to Covid-19.
Transplant organs are assigned according to complex criteria, including how long the patients have waited, how sick they are, how likely they are to survive with a transplant, and how close they are to hospitals that donate. The goal is to treat the most medically urgent cases first. The rules do not necessarily bump Covid-19 patients at the front of the queue, experts said, but many get sick enough to need immediate care.
That was the case for Al Brown, a 31-year-old car salesman in the Chicago suburb of Riverdale, Illinois, who caught Covid-19 in May and was diagnosed with congestive heart failure a few weeks later. In September, he woke up with severe chest pains that sent him to the emergency room.
“Shortly afterwards, they told me my heart works just like 10 percent,” Brown said. “It didn’t pump blood all over my body.”
Medicine did not solve the problem, so doctors offered him several choices, including a mechanical pump to temporarily help his heart – or a transplant. “They basically told me I was young and there was still a lot of life in my ear,” said Brown, the father of two young daughters. “I actually chose the option of a heart transplant.”
Brown, who regularly hit the gym, was an ideal candidate, said dr. Sean Pinney, co-director of the Heart and Vascular Center of the University of Chicago, said. “This man was healthy, except for Covid, except for heart failure.” Brown received his transplant in October and continues to strengthen.
Most Covid-19 transplants are performed on patients whose lungs have been irreversibly weakened by the disease. Thousands of Covid-19 survivors have developed ARDS, or acute respiratory distress syndrome, which causes fluid to leak into the lungs. Others develop pulmonary fibrosis, which occurs when lung tissue gets lesions.
“What was once a scaffold of soft, living cells is becoming a stiff mesh that cannot exchange gases,” Song said.
While conditions such as pulmonary fibrosis usually develop over months or years, often in response to toxins or medications, Covid-19 patients appear to become much sicker, much faster.
“Instead of months, it’s more about weeks,” Song said.
People still make a joke of it. But I was in the hospital for 170 days. You say to me: is it real or not?
These patients are regularly placed on mechanical ventilation and then on ECMO, or extracorporeal membrane oxygenation, in which a machine takes over the functions of the heart and lungs. Many get stuck on the machines, so sick that their only transplant or death.
Even then, not everyone is eligible for a transplant. In many Covid-19 patients, damage is not limited to a single organ. Others already have pre-existing conditions such as diabetes or obesity that may complicate the recovery of the operation or impede it completely. And those who have been anesthetized for weeks or months are unlikely to survive the trauma of transplantation.
Successful transplant candidates are likely to be patients younger than 65 who are otherwise healthy and whose lungs will not heal on their own, says Dr. Tiago Machuca, head of thoracic surgery at UF Health Shands Hospital, who assisted in drafting proposed guidance for Covid-19 relatives. lung transplants.
“It’s a very different profile of patients,” Machuca said. ‘These patients had normal lung function. They are young, and now they are engaged in mechanical ventilation or ECMO, fighting for their lives. ”
Mark Buchanan ended up in the situation last fall after his entire family caught Covid-19. His children, Jake (22) and Lauren (18), had mild cases. His wife, Melissa, was quite ill, although she was never admitted to the hospital, and had to help her quickly to help her husband.
“I just had to trust God and my family and friends,” she said. “It’s hard to explain how stressful it was.”
Buchanan survived the transplant and then recovered in Florida Hospital for three months. He lost over 70 pounds and was weak. “I could not brush my teeth or feed myself,” he said. “I had to learn to eat, swallow, talk, walk from scratch.”
Buchanan arrived home in January after a march of 400 neighbors and friends. He started talking to church groups and others about his struggle for a transplant. Many people in his small community remain skeptical about Covid-19. With a mask and holding distance, he tries to straighten it out.
“People are still joking about it,” he said. ‘But I was in the hospital for 170 days. You say to me: is it real or not? ‘
Buchanan has been one of at least 17 patients who have received Covid-19 lung transplants at Shands in the past year, the most from any hospital in the country. Machuca acknowledges its dedicated lung unit, which has already focused on patients with complicated breathing conditions.
It remains unclear whether widespread vaccination will stop the number of Covid-19 patients in need of transplants – or whether transplant candidates among survivors will continue to rise. However, there is no doubt that the pandemic has changed the profile of those considered for lung transplantation, Machuca said.
“Before Covid, transplanting patients with acute respiratory failure was a ‘no,'” he said. “I think it expands the boundaries of what we may feel.”