Big Lungs Carved For Petite Patient

Diagnosed with Interstitial Lung Disease and Scleoderma, 30-year-old Anita Devi’s only chance of seeing the next decade was with a lung transplant from a ‘tiny’ donor. Unable to find the right size, docs decided to get creative

CHENNAI:Standing at a little over five feet, swaddled in oversized clothes and a surgical mask, 30-year-old Anita Devi can easily pass for a lanky teenager — the kind who’s yet to hit her growth phase. While being petite is the new cool, it got her doctors really steamed up. Diagnosed with Interstitial Lung Disease and Scleoderma, the only way she could possibly live to see the turn of the decade was by getting a lung transplant.

And that’s where her petiteness got in the way. “She is hardly 5’1. Her lungs are really small and to get lungs that size we needed it from someone who’s 4’6 or something,” explained Dr Rahul Chandola, Heart and Lung Transplant Surgeon at Global Health City. As if a lung transplant wasn’t hard enough, they now needed lungs either from a dwarf or a child. Neither seemed possible. “We don’t get organs from children here and we had to refuse most of the lungs that were offered because they were too large to fit in her chest,” he added, showing CT scan images of her narrow cavity.

Instead, the surgical team decided to attempt something that hadn’t been done in the country, but had been honed in select surgical centres abroad over the last 15 years: cutting portions of the lung off to make it small enough to enter the chest cavity or Lung Reduction Transplantation. “She was deteriorating because of the high oxygen flow (she needed 4 litres a day) and finally we accepted a donor lung from a 42-year-old smoker who was 166 cm — much taller than her,” said Dr Vijil Rahulan, the attending pulmonologist.

Given that the lung was a lot larger than her chest cavity, they began to use specialised staplers to cut lung lobes on the sides and the middle, “We resected nearly 25 per cent of her middle and lower lobes, very anatomically, taking care that we took just enough off so that it would be capable of sufficient oxygenation. Normally, there are risks of leaks and tears in the organ wall, but this time it went off smoothly,” said Dr Chandola.

The resection was done after the lung was harvested and taken out of the cold case. After some sections were cut, it was put into Anita’s body and then minor resections and cuts needed to be made to ensure that it fit her well. Only after that was the pulmonary function gradually restored. “Normally, the lung has a high decay rate and is a very sensitive organ. We have only four to five hours in which to harvest and transplant it and it takes over an hour to do the resection, so if it had been brought in from another hospital we may have been cutting it fine,” said Dr Govini Balasubramani, Heart and Lung Transplant Surgeon.

Today, 45 days after the nerve-wracking six-hour surgery, all of them are breathing a whole lot easier. But none of them as much as Anita Devi. She’s showing off her new lungs with elan.

Breath of Life

•   The lung is a very delicate organ and out of 10 cadavers surgeons often get only one pair of good lungs
•   Very often lungs are damaged when the heart and liver are being harvested
•   Less than 24 per cent of donors have their lungs successfully transplanted
•   Size mismatches often lead to lungs being rejected, though the need for lungs is constantly growing in a country with rampant TB and other respiratory conditions
•   In India, 85 per cent of the lungs are rejected for various reasons — size mismatch is among the largest reasons

How does Lung Reduction work?

•  The clock begins ticking once the lung is harvested from the cadaver. 4.5 hours is the golden mark, though surgeons have stretched this to 6 hours by using freeze coolants and cold saline to buy them time
•  The chest cavity of the recipient is measured and based on the model needed, the lungs are reduced by cutting off minor lobes. The lung tissue is checked to ensure there is enough to provide pulmonary function for the body
•  The lung lobes that are to be cut are marked off and the organ is taken out of cold saline. Using special staplers, the portions are cut off and the surface is examined to see if there are any tears or cuts that will cause leaks
•  If there are none, the lung is placed in the chest cavity and minor corrections are made to ensure it fits without brushing against the body cavity and causing any manner of distress
•  The rest of the transplant is carried out, blood supply is restored to the lungs and pulmonary rehabilitation takes place