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Lung Transplant

at 14,000 feet

** When discussing or writing about organ donation or transplantation, more stringent privacy rules apply for the protection of all parties. For this reason, when discussing both the donor and the recipient, gender pronouns and other identifying features have been intentionally omitted. Post dates have been randomized to further prevent identification of recipients**

After spending most of the day in surgery with Dr. Lin, it’s time to meet with Dr.Lankala Reddy, the procuring surgeon and head for the airport.  Dr. Reddy, or “Shaker” as he’s known, has a clipped British accent, and confesses that he hasn’t be home to the UK since he came to Durham four years ago.  He came to Duke as part of his fellowship in Lung Transplant, and after completing his studies, stayed on as a procuring surgeon.  He also evaluates new patients for the Lung transplant program.

At the airport, we are met by two pilots and the final member of the procurement team, the preservationist on call, Lee Hinesley.  Lee is a lanky young guy with small laugh lines at the corners of his eyes which speak of his pleasant, and laid back manner.  “This isn’t Three Rivers,” he says with a wry smile, speaking of one of the popular melodramatic medical soap operas.  On the way to our destination, Lee pulls out a thick textbook and begins to read.  He’s studying for his certification as a preservationist. He’s completed all of his training some time ago, but the exam is only offered a few times a year he explains.

Like Lee says, our journey is ‘not like on TV.”  There is no frantic, controlled chaos or adrenaline surges.  Procedures have been streamlined and refined to eliminate most of the extraneous time-consuming variables. Routes are carefully planned, with several check-ins and updates to the surgical team back at Duke, who are awaiting our return.  Instead of hectic activity, there is calm and carefully scripted movements, as part of an established routine.  As one of the busiest transplant centers in the United States, the amazing, and incredible idea of taking an organ from one person, and placing it in another has become, if not quite routine, almost common.  So there is no need to worry; they have it all down to a science.

The plane itself is an executive jet; comfortable but by no means luxurious.  Rookie that I am, I am greatly relieved.  For some reason, I had pictured the close confines of a LifeFlight helicopter.  These flights aren’t called life flights – that term is reserved for the emergency flights that bring in trauma patients, and the critically ill; but in my mind – I’ve renamed our journey.  “Procurement” is such a cold, clinical term that erases all of the magic of the surgery.

(Now, readers should notice that I don’t usually talk in such fanciful terms, but to me, transplantation, like cardiac surgery doesn’t lose it’s awe-inspiring ability just because the medical community is ‘getting good at it.’   It’s still an amazing miracle every time, even if it’s done 140** times a year here at Duke.)

After flying across several states, we land at a small airport.  Within minutes, the plane for another surgical team (who are taking the heart) is landing.  We see them arrive through the window of the local sheriff’s vehicle.  He and another EMS person were waiting, to transport the teams to the “host” hospital.

The donor is tragically young, as they often are.  Looking at the donor, as we enter the operating room, I am stricken by how difficult this must have been for the family, during such an incredibly painful time.  Even as an experienced health care provider, I am taken aback.  I know that the donor has died, but (particularly in this case, where there is little visible injury) I feel deeply for the family; machines give the appearance of sleep with rise and fall of the chest though this patient will never wake up again.  What a caring, compassionate family they must be – to be giving at a time when they are hurting.  I hope this gives them solace in the future.

The staff of the local hospital are friendly, accommodating, if a little confused by all the unfamiliar, masked staff in the room.  Even without the official badges prominantly displayed the surgeons are easy to identify by their confident, self-assured manner.  I stay out of the way, standing near the anesthesiologist.  We banter a bit, and do the ‘six degrees of separation’ until we find several points in common, which awkwardly brings home the situation, as I consider the degrees of separation between donor and recipient.

The procedure itself is pretty standard, but intricate as vessels are gently untangled, ice applied and preservation solutions infused to protect the organs during transit.  Then steadily, quickly, efficiently but unhurried, the organs are packed for transport.  A quick thank you to the staff and we are off to the airport again.

When we land, we notify the operating room, and at 3:45 am, the surgeon wheels the cooler containing the lung into the operating room, where Dr. R. Duane Davis (and the patient) are waiting.

** current lung transplant procedures for the first six months of 2011, place estimates for year end totals around 140.

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About K Eckland

World of Thoracic Surgery is a blog about the work, research, and practices of thoracic surgeons around the world. It includes case studies, [sometimes] dry research, interviews with thoracic surgeons along with patient perspectives, and feedback.

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