Mother Donates Portion of Lung to Ailing Child : Medicine: The Stanford operation is the world’s first such transplant from a living person, surgeons say.
In what surgeons say is the world’s first lung transplant from a living donor, doctors at Stanford University Medical Center on Thursday removed one-third of the right lung of a 46-year-old woman and transplanted it into her 12-year-old daughter in a dramatic effort to save the girl.
The child suffers from a rare, invariably fatal lung disease known as bronchopulmonary dysplasia. She was listed in good condition after a four-hour operation, and physicians hope the procedure will enable her to live a normal life. Without surgery, she would probably have died in 12 to 18 months, the medical center said.
Surgeons cautioned that it will be days until they know if the operation was successful.
“At the present time, things look very good,” said Dr. David Latter, who assisted in the surgery. “The surgery was very smooth and the patient is awake in the intensive care unit.”
The surgery is considered highly experimental because less than 20 lung transplants have been done in children worldwide and because of the potential risk of the operation to the donor.
At the request of the family, names and personal details about the mother and daughter were not released. The child is expected to remain in the hospital for about three weeks and, if all goes well, to resume normal activity within a few months, her physicians said.
Before the surgery, she was experiencing breathing difficulties and infections and required oxygen at home.
The extension of live donor transplants to the lung is likely to raise anew discussion of the ethics of the procedure, which requires that the risks to a parent or other family member, including major complications or death, be balanced against the potential benefits to a severely ill family member.
“Live donations of lobes or pieces of solid organs is really steering into uncharted water,” said Arthur Caplan, the director of the Center for Biomedical Ethics at the University of Minnesota.
“I am personally not ready to do this yet,” said Dr. Chip Bolman, who directs the University of Minnesota’s lung transplant program. “If anybody is going to try this, the (Stanford surgeons) are as well qualified as any.”
Kidneys have been successfully transplanted from living donors since the 1950s, and the first successful liver transplant from a living donor was performed at the University of Chicago last November. There have also been a handful of living donor pancreas transplants at the University of Minnesota within the last year.
In total, 12 liver transplants from living relatives, in which a segment of the liver is removed, have been performed at the University of Chicago in the last year and 11 of the recipients have survived, a medical center spokesman said. The first liver donor lost her spleen; the other liver donors have not had serious complications.
Dr. Vaughn A. Starnes, the head of Stanford’s heart-lung transplant program, said a living related donor was used, instead of a dead unrelated donor, “with the hope of lessening the high rate of intense life-threatening rejection children have encountered in transplants involving the lungs.”
An equally important issue is the lack of suitable lung donors for children.
Although both of the girl’s lungs were damaged, the surgeons believe that replacing one lung with one lobe of an adult lung should sustain a healthy life.
Laboratory testing involving animals suggests that the transplanted lung tissue can increase in capacity and keep up with the girl’s growth, Starnes said. “The lobe is expected to function as an entire lung.”
The surgeries on the mother and daughter took place nearly simultaneously. First, the right upper lung lobe and related blood and breathing vessels were removed from the mother and flushed with cold solutions that helped to preserve their function.
Then, after the daughter’s right lung was removed, the lung lobe was attached. This involved connections of the lobe’s arteries and veins and the breathing tube known as the bronchus.
The child’s illness, bronchopulmonary dysplasia, causes scarring and high blood pressure of the lungs. It sometimes develops in premature infants with immature lungs who must be supported for long periods on a respirator.
For her mother, who has healthly lungs, the loss of the right upper lobe of her right lung will probably “mean nothing in the long term,” Latter said. “Once she has recovered from the surgery, I don’t think she will notice any impairment.”
Latter, who is a chief resident in cardiothoracic surgery at Stanford, explained that humans are born with “a remarkable excess of pulmonary function for day-to-day activities. We don’t come close to using our full capacity.”
Since the first successful lung transplant was performed in Toronto in 1983, there have been several hundred such surgeries performed worldwide. But all of the organs have been taken from cadavers and very few have been in children.
Adults who receive lung transplants have a one-year survival rate of between 70% and 80%. But, according to Starnes, children appear to be more likely than adults to reject a transplanted lung, perhaps because their immune systems are more active and anti-rejection drugs are less effective.
Pre-operative testing showed that “the mother was a far closer tissue match than could have been expected from an unrelated donor,” Starnes said.
In addition to the same blood type, mother and daughter shared four of six markers of tissue compatibility, known as antigens. Typically, unrelated cadaveric donors share two or fewer such markers with potential lung recipients.
“All in all, it just seemed a perfect situation to apply the concept (of living related lung donation),” Latter said.
