Double-lung transplants a Canadian success story

Main Category: Transplants / Organ Donations
Article Date: 12 Sep 2003 - 0:00 PDT

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Lawrence Weisgerber vividly remembers the summer night in 1988 when The Call came. He was 29 years old and had, at best, a few months to live. His lungs were failing, and his only hope was a double-lung transplant -- an operation that had never been performed on someone suffering from cystic fibrosis.

He had already spent 10 agonizing months on a waiting list, and hope was running out. A younger brother had already succumbed to CF.

'It was around midnight and I was sipping a beer -- which is about all I had the strength to do -- when the phone rang. I said: 'Let's do it.' '

Back then, Mr. Weisgerber's chances of surviving surgery were less than 50 per cent. His long-term prospects were a mystery.

Fifteen years later, the Vancouver cable TV technician is in seemingly perfect health. He works full-time, mountain bikes, and he is happily married -- to another double-lung transplant recipient.

'My life has been good, it's been great. I got a second chance, and I'm making the best of it,' he said in an interview.

New data released yesterday show that he is not alone.

In recent years, the number of lung transplants in Canada has risen dramatically, survival rates have soared, and waiting times have shrunk.

'This is truly a Canadian success story,' said Shafique Keshavjee, director of thoracic surgery research at Toronto General Hospital.

'What we're seeing is the wonderful result of experience and research, but because it's a young field, we hope to make a lot more progress.'

The world's first successful lung transplant was performed at Toronto General in November of 1983. The recipient, 58-year-old Tom Hall, lived another six years.

By 1988, when Mr. Weisgerber went under the knife, there were 23 transplants. But less than 40 per cent of patients lived another three years. And fewer than one in 10 of donated organs could be used.

Last year, 141 Canadians received new lungs, according to data released yesterday by the Canadian Institute for Health Information. That is 7 per cent of total organ transplants.

The three-year survival rate for lung recipients now exceeds 70 per cent. And the lungs of almost four in 10 organ donors can now be used.

Dr. Keshavjee said that because of their fragility and complex connections to the heart, lungs are the most difficult organ to transplant (aside from the brain, of course).

'Twenty years ago, we could only use lungs that were perfect -- and there aren't that many after a donor has suffered trauma and been on a ventilator,' he said.

'But we've learned how to better access the lungs, repair them, and preserve them, and we've improved our surgical techniques. As a result, many more patients are benefiting from transplantation.'

The only bedevilling factor is that, in a country that has been a pioneer in lung transplantation, there are simply not enough lungs for all the people who need them.

At the end of 2002, there were 150 Canadians awaiting lung transplants.

Last year, 26 patients died while on the wait list.

'Organ donation hasn't kept pace with the need for organs so the lack of lungs continues to be the most pressing problem facing patients with end-stage lung disease,' Dr. Keshavjee said.

Peter Cantisano, a retired engineer, received two new lungs on Canada Day after six months on the waiting list. 'The hardest part is the wait, because you don't know if you're going to live or die,' he said.

Until he became critically ill with emphysema, Mr. Cantisano had never given thought to signing an organ donor card, but he has now become a fervent proponent. Donor cards are included with health cards and/or drivers' licenses in most provinces.

'I never realized just how important that signature was until my life depending on it. Now, my attitude is if there's any part of my body they can use after I'm dead, they can have it,' Mr. Cantisano said.

The 64-year-old is an example of how lung transplantation, and recovery from the operation, has changed. Just weeks after undergoing surgery, he is out and about. He even posed yesterday for photographers as he walked briskly on a treadmill.

'I feel like I'm nine weeks old because I'm starting a whole new life,' Mr. Cantisano said.

For now, he takes more than 40 pills daily, a potent cocktail of antirejection drugs and antibiotics, because he is highly susceptible to infection. The quantity of medication will fall, but be required life-long. The antirejection drugs are toxic, particularly to the kidneys.

Researchers have learned that most long-time transplant survivors will, at some point, need a kidney transplant.

Mr. Weisgerber got his new kidneys three years ago, an event that made him appreciate anew, the importance of the organ donor card.

'I think of the donors every single day. They've given me lungs and kidneys, literally, but they've also given me a heart and soul,' he said.

'My goal now is to live until I'm 92 and I know that I couldn't do it without them.'

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