By Tracie White
Alicia Bland, 54, was leaving Stanford’s lung pre-transplant clinic after a routine appointment when she received a phone call that, at first, she thought was a joke. She’d been on the waiting list to receive lungs from a donor patient for only about a month, so she was stunned she was already getting the call.
“They say they have some lungs for me!” she excitedly told her caregiver, Roscoe Little, who accompanies her on appointments. Then she ran down the hall, barely able to breathe, to catch Joell Garner, RN, a pre-transplant coordinator who had been working with her for two years, preparing her for a desperately needed lung transplantation.
“She stopped me in the hallway,” Garner said. “It was amazing to witness. She was like, ‘Oh my gosh. What do I do? They told me they have lungs for me.’ She was completely breathless. I had to tell her to sit down.”
Twenty-four hours later, Bland, who had been struggling to breathe for nearly three decades, had her diseased lungs removed and replaced with the healthy lungs of someone who had recently died and donated their organs. Finally, she could breathe freely again.
“I hope to be able to reach out to his family,” Bland said. “I feel like I’m a part of them now.”
Bland’s transplant procedure was the 1,000th by the Heart-Lung & Lung Transplantation Program at Stanford Health Care since Stanford’s first heart-lung transplant in 1981. That year, cardiothoracic surgeon Bruce Reitz, MD, performed the world’s first, operating on Mary Gohlke, a 45-year-old Arizona woman dying of primary pulmonary hypertension. In the years since, about 250 heart-lung transplants have been performed at Stanford along with 750 lung transplants.
A Transplant Truly Takes a Village
“It’s a milestone,” said Gundeep Dhillon, MD, a transplant pulmonologist and medical director of the program. “A lung transplant is something that truly takes a village, one that includes the patient; his or her caretakers; the donor and the donor’s family; our interdisciplinary team of health care providers, including surgeons and nurses; a rehabilitation team; pulmonologists; dieticians; therapists; and more. It’s an amazing team effort.”
Since that first transplant at Stanford in 1981, patient outcomes have continued to improve, Dhillon said, now reaching a five-year survival rate of 60% for heart-lung and lung transplant patients. The survival rate continues to rise due to improvements in surgical techniques, as well as pre- and post-transplant care. But a lung transplant remains a major undertaking for any patient and can often be overwhelming, he said.
“They go through this roller coaster of emotions,” said Dhillon, who, as a pulmonologist, cares for patients before and after surgery. “They’re very sick, and then they’re waiting for the organs to come while further deteriorating. After surgery, there’s a euphoric phase, but being a transplant patient remains a lifelong commitment with continued monitoring by the clinic team and the need to take immunosuppressant drugs.”
Bland couldn’t be happier with the outcome of her lung transplant. Her breathing capacity increased from just 24% to a high of 82% within a few weeks after surgery. For the first time in 13 years, she’s no longer attached to an oxygen tank.
“The transplant team, they’re my angels,” she said. “They gave me a second chance at life.”
The 24-hour Blur
After Bland received the phone call from the cardiothoracic surgery department telling her that donor lungs had become available, the next 24 hours were pretty much a blur. She was immediately called into surgery, but whether the transplant would actually occur remained unknown.
“Once we accept a donor organ, we call the patient into the hospital right away so they are ready at any time,” said John W. MacArthur, MD, assistant professor of cardiothoracic surgery and Bland’s transplant surgeon. “But we don’t know if the lungs are good quality until a Stanford surgeon takes a look.”
While Bland and MacArthur waited at Stanford Hospital, another Stanford surgeon traveled to the hospital where the donor patient remained to ensure the lungs would work. Once the lungs were determined to be a good match, the surgeon recovered them, then brought them to the operating room at Stanford in a sterile cooler filled with ice. At that point, Bland had a breathing tube inserted, was given anesthesia and was connected to monitoring devices.
While Bland was on a cardiopulmonary bypass machine, which kept her alive during the procedure, MacArthur removed her original lungs and transplanted the donated ones in their place.
“This surgery went very smoothly, and the patient had a really good recovery,” said MacArthur, who added that he loves doing this type of procedure because of the quick and dramatic improvement in his patients. “It’s challenging, but it’s very rewarding to see somebody who can’t breathe comfortably, or not well at all, go home and not need any supplemental oxygen.”
Bland had her surgery on Oct. 10 and was released two weeks later to her home in San Jose.
An Inflammatory Disease, the Start
Bland’s ordeal began when she was 22 years old and started having trouble breathing. She was diagnosed with sarcoidosis, an inflammatory disease with no known cause that often results in serious damage to the lungs. Her doctor told her she had only about 10 years to live.
“I told my mother, don’t cry,” Bland said. “Doctors are often wrong. God had a different plan for me.”
Bland lived with the disease for decades, under regular medical supervision, unable to work and struggling to breathe. When her grandson was born three years ago, she was too weak to hold him. As the years passed and her lungs worsened, her doctors told her that she required a transplant and that she needed to move out of the San Joaquin Valley because its poor air quality was exacerbating her condition.
“I was scared,” Bland said. She was almost as scared of having a lung transplant as she was of dying. But eventually she moved to San Jose with her longtime friend and caregiver, Little, and began visiting Stanford’s pre-transplant clinic two years ago.
Finally Added to the Transplant List
“They told me I needed to lose weight before I could be put on the transplant waiting list,” Bland said. It wasn’t easy, and it took a long time, but she dropped 30 pounds with the help of dieticians, nurses and counselors at the clinic. At the end of August, Bland was finally added to the transplant list.
Bland still has chest pain where the stitches remain and severe indigestion, common after surgery. She’s walking a bit, but uses a walker when her legs begin to wobble. Her health care team tells her all this should subside soon. For now, her X-rays look good, her blood count is good and, most importantly, her breathing is good.
“Alicia, you’re doing great,” Dhillon told her the last time he saw her in clinic. “Your lungs look beautiful.”
“That’s so nice to hear,” she said, looking up with a smile.