MUSC re-establishing lung-transplant program, only one in S.C.
By David Quick
The Post and Courier
CHARLESTON -- It's something most of us take for granted. Breathing. Simple breathing.
But take a few seconds to think about the life of former police officer Corey Roper.
The 40-year-old Johns Island resident speaks in a tender voice, as if it hurts to speak louder, because, in fact, living his life is a daily struggle. For example, he has difficulty bending over because of fluid in his lungs. He can't cut the lawn or ride a bike with his daughter. And a short walk from his parked car and up one set of stairs into a building in downtown Charleston on a sweltering summer day left him winded and exhausted.
"It was like I walked from here to James Island," says Roper, describing the exertion. "It's like somebody was suffocating me."
Roper first started noticing problems in 1995 when he worked as a police officer for the State Ports Authority in North Charleston and the fumes from the nearby Westvaco plant made him "cough and gag." It became so bad that his doctor requested that the SPA transfer him.
In December 2006 -- four years after being diagnosed with scleroderma, an autoimmune disease that attacks the organs -- one of Roper's lungs collapsed and he was hospitalized. A month later, the other lung did the same. His doctor said that Roper would need a lung transplant, but because of the risks involved with working, he retired.
Currently, he is on the list for lung transplants at New York Presbyterian Hospital, where he must travel for routine check-ups three times a year.
He and others who are in his pulmonary rehabilitation class at the Medical University of South Carolina, however, have reason to celebrate this year.
After 13 years, MUSC is re-establishing its lung-transplant program.
Keeping lungs in S.C.
MUSC had a program for about three years in the mid-1990s and performed about 25 lung transplants, but the administration realized it wasn't quite ready for the program because of the intensity of the transplant operations and place a moratorium on the program, according to Dr. Fred Crawford, who was head of the surgery and cardiothoracic departments at the time.
"Lungs are a whole other story," says Crawford, famed for heart transplants. "The patients are sicker, more complicated and require more recovery time."
At the time, he says, MUSC didn't have enough intensive-care hospital beds or staff.
"It overwhelmed our nursing and resident staff," says Crawford. "Lung transplants require much more than a surgeon."
However, with the completion of the new Ashley River Tower, it gave MUSC the facilities to restart the program, starting with some key additions.
The school recruited two key staffers, Dr. Timothy Whelan of the University of Minnesota and Dr. William Yarbrough of Stanford University, to be the lung transplantation medical director and a heart and lung-transplant surgeon, respectively.
The MUSC lung-transplant program expects to get approval from the federally commissioned United Network for Organ Sharing in September and to perform a transplant in early fall.
Re-establishing the program and being the only lung-transplant program in South Carolina has other implications.
In recent years, the state's organ-procurement organization, LifePoint, has secured about 60 viable lungs annually and currently is on track for 100-plus this year. Those lungs have been sent out of state. With the MUSC program, it gets first dibs, which bodes well for residents of South Carolina who have reached the end of medical therapies and simply need new lungs.
Most of those patients now are on waiting lists at Duke University. And while they may join the list for MUSC, it won't negate their ability to be on waiting lists at other hospitals. One reason patients from South Carolina, and particularly the Charleston area, may want to have surgery at MUSC is that postsurgery recovery can take up to a year and requires being near the hospital where the surgery was done.
Whelan is enthusiastic about MUSC's potential for creating a new niche in lung-transplant surgery and research.
"We have a tremendous team of pulmonologists, the appropriate mix of patients and an appropriate donor pool to be successful," says Whelan. "There's no question in my mind that MUSC will have a successful lung-transplant program."
A smoker's problem?
"It used to be true that most transplants were due to smoking-related diseases, COPD (chronic obstructive pulmonary disease) and emphysema," says Whelan. "That's no longer true."
Whelan says that when the organ-sharing network changed its policy on scoring potential transplant recipients in 2005, priorities shifted to two key factors: first, the likelihood of dying while waiting for a lung or lungs; and second, dying within a year of getting a lung or set of lungs.
The change placed a higher score on those suffering with idiopathic pulmonary fibrosis, a progressive lung disease that scars lung tissue and leads to the inability of oxygen to be transferred to the bloodstream.
The origin and development of IPF is still not completely understood, but genetics, exposure to occupational or environment dusts, viral and bacterial infections, certain medicines, acid reflux and cigarette smoking, may be factors.
While IPF and COPD remain two major reasons for lung transplants, another major group includes those with cystic fibrosis, an inherited disease that causes thick, sticky mucus to build up in the lungs and digestive tract. Those with cystic fibrosis needing lung transplants usually have the surgery in their 20s or early 30s, according to the Mayo Clinic.
Cost and effectiveness
A lung transplant is an expensive surgery, particularly for an average survival rate of about five years. The total bill -- surgery, drugs and follow-up -- tends to run $250,000 to $300,000.
While Whelan says it's easy to put a dollar amount on the cost of the surgery, it's more difficult to answer questions of whether it's worth doing.
As for the relatively short life spans after surgery, he notes that there are always exceptions and that as more transplants are done, doctors will learn more about how to extend lives.
16 years and counting
Selma Tennant of Sumter was the third recipient of a lung transplant at MUSC back in 1994, when she was 28 and the mother of two young daughters.
Tennant had rheumatoid arthritis, which led to the development of "bronchiolitis obliterans," an obstructive lung disease in which the bronchioles, small airway branches, are compressed and narrowed by scar tissue and inflammation. It left her unable to do routine duties as a mother and dependent on oxygen 24 hours a day, and caused her 5-foot-1-inch body to wither to 87 pounds.
She received a single lung transplant, the rheumatoid arthritis went into remission and she watched her family grow up.
"I saw both my girls graduate and get married," says Tennant, now 44. "I also have a grandson now."
Like many organ transplant patients, Tennant has remained close to the MUSC program, its staff and other patients, and she's happy that lung transplants will be part of it once again.
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