After successful lung transplant, challenging recovery awaits girl with cystic fibrosis

By | June 13, 2013

Sarah Murnaghan, the 10-year-old Pennsylvania girl at the middle of an organ transplant battle, finally underwent her long-awaited lung transplant on Wednesday.

I am so happy that this little girl got a new chance at life.  All of us who have been following this case so closely realize just how critical this child has been for the future of organ transplantation.

On Tuesday night, Sarah’s mother, Janet, said they had found a match for her daughter.  And with the great skill of her surgeons and nurses, along with the support of everyone involved in her care, the technical part of her surgery has been successful.  

Throughout this whole ordeal, I never lost hope that Sarah would become a candidate for transplant surgery. And I think it speaks volumes about the spirit of the American people who stood behind her and demanded she get a fair shot at life.

But the doctor in me tells me we have to be cautiously optimistic because there are still major hurdles that Sarah has to overcome.

From a medical standpoint, in cases like this one, there is always the worry about infection.  Organ transplants require large complex surgeries with organs that are very prone to infection – especially the lungs.  And moving forward, Sarah has to undergo immunosuppressive therapy, which predisposes her to the development of infection.

There are also significant issues of metabolism.  The function of the lungs is to oxygenate the blood, but this oxygenation contributes to the overall metabolic stability of the body.  Right now, it’s too soon to tell whether her metabolic condition can be stabilized through these new lungs.

Finally, with any organ transplant surgery, you also have the possibility of organ rejection, which could theoretically develop over the course of the next few days.  The good news is that she is young, and she is receiving the best health care possible.  

I spoke to Dr. Donald McCain, chief of surgical oncology and the vice chairman of the John Theurer Cancer Center at Hackensack University Medical Center in N.J., about other potential obstacles Sarah faces.  He noted that because the donor was an adult, resizing the lungs may also create medical issues.

“The size of the lungs are much too great, which is why they don’t use adult lungs in general (for pediatric patients),” McCain said.  “They must remove part of lung tissue, and…you have to do that surgically, creating a surgical line that didn’t exist before.  That surgical line normally will not have the same strength as obviously a non-surgical line.  That creates a potential weak point that is risky for an air leak.”

McCain also added that even if Sarah overcomes these hurdles, there is a long road of recovery ahead.

“Lung transplants are some of the sickest patients you wind up having, unlike liver and kidney transplant patients, who usually do quite well,” McCain said.  “With lung transplants, these patients are in the hospital a very long time and are usually very sick.”

To me, the aggravating part of this story is that this sweet girl only got her chance at life at the last minute.  Had she been placed on the adult organ transplant list earlier, perhaps her condition would have been a little bit stronger when she received her new lungs. But I’m still very optimistic that Sarah will have a good recovery.

It saddens me that it finally took a judge to see the common sense and force HHS Secretary Kathleen Sebelius into doing the right thing.  I just hope that other children under similar circumstances get the justice they deserve in enough time.

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