Covid creates ‘whole new category’ of organ transplants

In a year when Covid-19 shook the pleas of so many who prayed for miracles, a Georgia man with two new lungs is one of the lucky ones.

Roopville’s Mark Buchanan received a double lung transplant in October, almost three months after Covid hospitalized and sedated him, first on a ventilator and then on the final treatment known as ECMO.

“They said it ruined my lungs,” said Buchanan, 53, who was a burly utility company lineman when he got sick. “The vent and the covid completely ruined them.”

At the time, only a handful of US hospitals were willing to take advantage of organ transplants to treat the sickest patients. Too little was known about the risks of the virus and the permanent damage it could cause, let alone whether such patients could survive the operation. According to his wife, Melissa, Buchanan was rejected at Emory University Hospital in Atlanta. The doctors advised her to stop treatment and allow him to die peacefully.

“They told me to end his life. I told them absolutely nothing, “recalls Melissa Buchanan, 49.” We all started Googling every place that could accommodate someone in need of a lung transplant. “

Calls to multiple hospitals and a hometown doctor favor were answered before Buchanan was admitted 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 has changed radically. Covid-related transplants are on the rise as hospitals grapple with growing numbers of patients whose organs – mostly hearts and lungs – “are basically being destroyed by the virus,” said Dr. Jonathan Orens, lung transplant specialist at the Johns Hopkins University School of Medicine in Baltimore.

Almost 60 transplants had been performed by March 31 for patients with covid-related organ disease. That comes from figures released Monday by the United Network for Organ Sharing, which monitors transplants in the United States. This includes at least 54 lung and four heart transplants since new codes for covid-specific diagnoses were passed in late October. One patient received a combined heart-lung transplant. Another 26 patients eligible for covid-related lung transplants and one eligible for a heart transplant are still on waiting lists, according to UNOS.

Nearly two dozen hospitals have performed the operations, and new locations are added every month.

“You see it moving all over the country, and it’s moving pretty fast,” said Dr. David Weill, former director of the Lung and Heart-Lung Transplantation Program at Stanford University Medical Center who is now a consultant. “It’s like wildfire with the centers saying, ‘We did our first too.'”

The surge in transplants has been largely fueled by the wide range of the virus. Thousands of patients who have survived particularly severe infections have 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 Medical Center. “I expect this to be a whole new category of transplant patients.”

Tens of thousands of patients whose organs were otherwise healthy have developed a severe chronic lung disease after contracting Covid. Because it is a novel disease, it is not yet clear how many people will need lung transplants, said Weill, who has called for a lung transplant registry to be developed to track the results.

So far, the surge in Coviden-related transplants has not dramatically affected existing organ waiting lists. Of the more than 107,000 patients on waiting lists, around 3,500 need hearts and more than 1,000 lungs. Most of the others are waiting for kidney transplants that haven’t seen a significant increase due to Covid.

Transplant organs are assigned based on complicated metrics, including how long patients have waited, how sick they are, how likely they are to survive with a transplant, and how close they are to donor hospitals. The aim is to treat the most medically urgent cases first. The rules don’t necessarily put eager patients on top, experts said, but many get sick enough to need immediate care.

Such was the case of Al Brown, a 31-year-old auto salesman in a suburb of Chicago, Riverdale, Illinois, who contracted Covid in May and was diagnosed with heart failure a few weeks later. In September, he woke up with severe chest pains, which sent him to the emergency room.

“Soon after, they told me my heart was only working at 10%,” Brown said. “It didn’t pump blood all over my body.”

Medication didn’t fix the problem, so doctors offered him several options, including a mechanical pump to temporarily help his heart – or a transplant. “They were basically telling me I was young and that I still had a lot of life in me,” said Brown, the father of two young daughters. “I actually chose the option of a heart transplant.”

Brown, who had been to the gym regularly, was an ideal candidate, said Dr. Sean Pinney, co-director of the Cardiovascular Center at the University of Chicago Medicine. “This guy was healthy, except for Covid, except for heart failure.” Brown received his transplant in October and continues to recover.

Most Covid-related transplants are performed on patients whose lungs have been irreversibly weakened by the disease. Thousands of Covid survivors have developed ARDS, or acute respiratory distress syndrome, in which fluid can enter the lungs. Others develop pulmonary fibrosis, which occurs when the lung tissue becomes scarred.

“What was once a framework of soft, living cells is turning into a stiff network that cannot exchange gases,” said Song.

While conditions like pulmonary fibrosis typically develop over months or years, often in response to toxins or medication, Covid patients seem to get much sicker and much faster. “It’s more on the order of weeks than months,” said Song.

These patients are often mechanically ventilated and then treated with ECMO or extracorporeal membrane oxygenation, with a machine taking over the functions of the heart and lungs. Many get stranded on the machines and are so sick that their only option is transplant or death.

Even then, not everyone is eligible for a transplant. For many Covid patients, the damage is not limited to a single organ. Others have pre-existing conditions such as diabetes or obesity, which can make recovery after surgery difficult or impossible. And often those who have been sedated for weeks or months do not survive the trauma of a transplant.

Successful transplant candidates are likely to be patients under 65 who are otherwise healthy and whose lungs are not healing on their own, said Dr. Tiago Machuca, chief of thoracic surgery at UF Health Shands Hospital, who helped develop guidelines for covid-related lung transplants.

“This is a very different profile of patients,” said Machuca. “These patients had normal lung function. They are young and are now on mechanical ventilation or ECMO and are fighting for their lives. “

Mark Buchanan ended up in this situation last fall after his whole family had fun. His children, Jake, 22, and Lauren, 18, had mild cases. His wife Melissa was quite ill, despite never being hospitalized, and had to turn to quickly to help her husband.

“I just had to rely on God and my family and friends,” she said. “It’s hard to explain how stressful it was.”

Buchanan survived the transplant and recovered in the Florida hospital for three months. He lost more than 70 pounds and was weak. “I couldn’t brush my teeth or feed myself,” he said. “I had to learn to eat, swallow, talk, start all over again.”

Buchanan came home to a parade of 400 neighbors and friends in January. He has started speaking to church groups and others about his fight for a transplant. Many people in his small community are still skeptical about Covid. He wears a mask and keeps his distance to straighten it out.

“People still make a joke of it,” he said. “But I was in the hospital for 170 days. You tell me: is it real or not? “

Buchanan was one of at least 17 patients who received covid-related lung transplants in the past year in Shands, the largest part of a hospital in the country. Machuca credits his special lung unit, which had already focused on patients with complex respiratory diseases.

It remains unclear whether widespread vaccination will curb the number of Covid patients who need transplants – or whether the number of transplant candidates among survivors will continue to increase. However, there is no doubt that the pandemic has changed the profile of those considered for a lung transplant, Machuca said.

“Before Covid, transplanting patients with acute respiratory failure was a no,” he said. “I think this is pushing the boundaries of what we thought was possible.”

KHN (Kaiser Health News) is a national newsroom that produces extensive journalism on health issues. Alongside Policy Analysis and Polling, KHN is one of the three most important operational programs of the KFF (Kaiser Family Foundation). KFF is a foundation that provides health information to the nation.


This story can be republished for free (details).

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