Double lung transplants are allowing seriously ill patients to survive COVID-19’S ‘bomb blast’
CHICAGO – At a dark moment over the summer, Rodney Wegg was forced to consider removing his wife from life support.
After testing positive for COVID-19 in July, Kari Wegg, a previously healthy nurse, worsened until she was placed on a ventilator and given a grim outlook for survival.
“Give me some more time,” Wegg’s doctor told her husband, offering him and their two sons a glimmer of hope.
Their perseverance paid off when, months later, Wegg, a 48-year-old neonatal intensive care unit nurse, awoke as the sixth COVID-19 patient at Northwestern Memorial Hospital to receive a groundbreaking lung transplant surgery, free of the disease and breathing with two new lungs.
The double lung transplant surgery for critical COVID-19 patients, which was first performed in the U.S. at Northwestern in June, has now been done seven times at the Chicago hospital by Dr. Ankit Bharat, chief of thoracic surgery and surgical director of the Northwestern Medicine Lung Transplant Program, and a team of surgeons. The surgery is considered more difficult than other lung transplants because of the damage COVID-19 has done to the organ, Bharat said.
Despite the high-risk nature of the surgery, some transplant centers around the country have begun performing the operation. And at least one other Chicago hospital has considered doing the procedure, though the transplant surgeon warned of its difficulties. Meanwhile, calls from across the country continue to come for Northwestern, which has performed more of these surgeries at this point than any other hospital in the world, Bharat said.
“Every day we get four to six phone calls at a minimum,” Bharat said.
The requests can be disheartening because often they come from people who are too sick for the surgery. The hospital also has its own capacity limits for how many people can be accommodated.
But with at least three more patients accepted for surgery, Bharat is hopeful that the hospital has honed a procedure that can offer a last chance for otherwise terminal patients.
The patients have come from as close as Indiana and as far as Texas and Washington, D.C. They must temporarily relocate to Chicago for about a year after the surgery in order to be near the hospital for recovery and extensive rehab that includes building muscle and mastering walking and even more strenuous activity again.
A number of the patients have rented small apartments, and are staying connected with family and friends back home through video chats.
One of those patients is
Wegg, who is from suburban Indianapolis, but was taken to Northwestern after she was approved for the surgery.
“I feel so lucky,” Wegg said from her hospital bed, growing emotional.
As of Wednesday, the United States had surpassed 11.4 million COVID-19 cases since the beginning of the pandemic, with more than 248,000 deaths. Cases across the country, and in Illinois, have been surging upward.
As these most critically ill patients speak out, they have the same message for other people as cases rise to alarming levels:
Wear a mask. Wash your hands. Stay home when you can.
“With all those things, you are saving someone else’s life, and even your own,” Wegg said.
In the spring, as COVID-19 infections flooded into Chicago hospitals, Bharat watched with dismay at the severity of infection in people who were previously very healthy, like a personal trainer, in prime physical fitness, who became very ill.
Bharat was on the hospital’s coronavirus task force that was searching for treatments to save some of the critical patients. Lung transplants had helped COVID-19 patients in Europe and China, but Bharat said there was some concern at Northwestern about the risks of the procedure.
“There were a lot of doubts amongst our team,” he said. “It was the height of the pandemic. We didn’t know if it would work.”
They also were worried about risking the health and safety of health care workers.
But when 28-year-old Mayra Ramirez appeared to be near death, the team decided to perform the first surgery, Bharat said. The surgery was successful and Ramirez is doing well, he said.
“Our team didn’t want to give up on her,” he said.
When any transplant patient needs an organ, a national system gives them a rating based, for the most part, on how sick the person is, with the highest rating of 100 for the most urgent cases, Bharat said. The COVID-19 transplant patients have received ratings in the range of 80 to 90, he said.
As he performs the surgeries, Bharat remains amazed at the damage COVID-19 has done to people’s lungs.
“It’s like a bomb blast has gone off,” he said.
The surgery lasts about 10 hours, and usually requires eight to 10 units of blood — a startling contrast to the half unit needed for other, non COVID-19 lung transplants.
“It shows you how sick they are, how much bleeding happens,” he said.
He has been urging other hospitals to consider offering the surgery, though he said associations that regulate transplant centers track mortality rates, which can make some hospitals reluctant to take on risky procedures that could downgrade their ratings.
“Because of a lot of these pressures, centers have to be very careful in what types of cases they do,” Bharat said.
Still, he pointed to a 100% survival rate over 30 days for his seven patients. The patients, who were otherwise terminal, are all doing well so far. The hospital will continue to track their progress over a longer period of time.
“We want to help everybody but we only have so much capacity,” he said.
The University of Chicago Medical Center has consulted with a handful of COVID-19 patients about a lung transplant, but they weren’t good candidates, either because they were too sick, or would recover without a transplant, according to Maria Lucia Madariaga, a transplant surgeon and assistant professor of medicine at the university.
“We are definitely open to the possibility, but the patient needs to be very specific patient,” she said.
Madariaga said a candidate for that surgery would likely need to be a younger person who was relatively healthy before the COVID-19 infection. She said lung transplants come with a long recovery, and patients in general have a lower rate of survival in the long term than other organ transplant patients.
“It requires a lot of judgment in an arena where there are so many unknowns, and lung donors are very rare,” she said.
Overall, the doctors say the procedure is an absolute last resort, so they are asking people to remain cautious.
As cases in Illinois rise at an alarming rate, Bharat warns that no one is immune from contracting a severe case of COVID-19. His seven patients are all ages, come from different ethnic and socioeconomic backgrounds and were all previously pretty healthy.
“People really need to take this seriously,” he said.