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First lung transplant

On 19 November 2000, surgeons at the National Heart Centre performed Singapore's first lung transplant operation on Thanvanthri N. Veerappan, 54, a shipping consultant. The team of lung transplant surgeons included two directors of Singapore's heart-lung programme, doctors S. Sivathasan and Tong Ming Chuan, and lung expert, T. Agasthian (Dr). In an operation that lasted about nine hours, the team successfully transplanted a pair of healthy lungs from the late Yap Chee Kian, 39, to Thanvanthri.

Background
Lung transplantation is a necessary treatment for lung diseases that cannot be cured by medication. A lung transplant is as complex as a liver transplant and technically more difficult than a heart transplant. It is also difficult to get lungs as transplant organs because they must not be damaged or infected. As such, ruptured lungs from accident victims are often unsuitable for transplants. Although technology and expertise for lung transplantation were already available at the National Heart Centre by mid-2000, no suitable donor had yet been found.

Doctors use three criteria to determine a lung transplant recipient. Donor lungs are matched with recipients according to their lung size, chest measurements and blood type. The donor's and recipient's lungs must be of the same size with not more than a ten percent difference. Their blood groups must be compatible. When donor lungs are available, they are given to the person on the waiting list who matches the donor size and blood group most appropriately, and the patient most in need of it, not the patient who has waited the longest.

History
On 19 November 2000, the decision to carry out the first lung transplant in Singapore was taken. This was because a suitable donor had been found for the patient who needed it the most at the time, Thanvanthri N. Veerappan, a male aged 54. It was found that the donor had O-type blood, a universal donor.

The lung recipient, Thanvanthri, a non-smoker, was first diagnosed with pulmonary fibrosis, or scarring of the lungs, in mid-1995. It was not known what caused his condition. From 1998, his condition deteriorated causing difficulty in breathing and he was tired out easily. He was finally hospitalised where he was hooked up to a respirator which provided him with 10 litres of oxygen daily. By 15 November 2000, his condition became so critical that doctors gave him only weeks to live. All Thanvanthri could do was to wait for the possibility of a donor lung.

A few days later, Yap Chee Kian, a Chinese female aged 39, suffered a stroke while visiting her mother at the Tan Tock Seng Hospital. She was rushed to the Accident and Emergency Department and was diagnosed with a brain haemorrhage. She was admitted to the National Neuroscience Institute (NNI), next to Tan Tock Seng Hospital. She died on Saturday morning, 18 November 2000, 24 hours after being first admitted to the NNI.

Yap's husband, Choo Hong Seng, a hotel engineer, was devastated by his wife's sudden death. Although he was in deep grief, he readily agreed to donate her organs when approached by a transplant coordinator from the Singapore General Hospital (SGH). He did so after consulting with his late wife's father who gave his approval. Choo felt that it was the right thing to do as others would benefit from her donated organs. Doctors removed her lungs, kidneys, eyes and skin for transplants.

Description
On 19 November 2000, a team of lung-transplant surgeons, including the two directors from Singapore's heart-lung programme, doctors S. Sivathasan and Tong Ming Chuan, worked from about 8:00 pm. until about 5:00 am. the next morning to remove and transplant Yap's lungs to Thanvanthri. Another doctor, T. Agasthian, a lung expert, was also involved. Time was critical as donor lungs should be transplanted within six hours of being removed. The transplanted lungs, which were packed in ice, were rushed from the NNI to SGH where Thanvanthri had already been prepared, and the operation had to continue through the night.

Post-operation
Initially, doctors were not very optimistic about Thavanthri's recovery as on the day he received his new lungs, his body had showed signs of tissue rejection. He suffered a bout of pneumonia a week after the operation, which put him back into the intensive-care ward for four days. However, Thavanthri pulled through and a month later, he was well enough to go home. He was feeling much better and could talk without gasping for breath.

According to international data, half of lung-transplant recipients live at least for five years. Chances of survival are greater if there is a better match in terms of blood type and lung size between donor and recipient. Thus, doctors monitored Thavanthri's condition closely for the first six months after the operation, the most risky phase for rejection and infection. Within those six months, his body rejected the new lungs more than once and he had several attacks of infection. Daily, he struggled against fever, throbbing headache, unending diarrhoea and nausea. In June 2001, an infection caused the blurring of his left eye which left it permanently damaged. The transplant also weakened his immune system leaving him vulnerable to even common colds. Doctors feared that he might not survive.

From February 2002, his condition stabilised and doctors were more confident that he would survive beyond five years. Thavanthri still goes for check-ups, and although his highly-subsidised medical bill comes to about S$600 a month, he is grateful that he is not bed-ridden and is able to breathe without complications.

Author
Nureza Ahmad



References 
Donor needed for first lung transplant. (2000, May 19). The Straits Times.

Kaur, S. (2003, October 6). With new lungs, he's grateful for each new day. The Straits Times.

Leong, P., & Salma Khalik. (2001, January 17). Blow for organ donors husband. The Straits Times.

Salma Khalik. (2001, November 15). First lung recipient marks year at Deepavali. The Straits Times.

Salma Khalik. (2000, November 22). Lung transplant first for Singapore. The Straits Times.

Salma Khalik. (2000, December 22). Gift of life this festive season in first lung transplant here. The Straits Times.

Salma Khalik. (2000, December 22). She is dead, but lives on in others. The Straits Times.

World-firsts and success for researchers in Singapore. (2000, December 28). The Straits Times.

The information in this article is valid as at 2004 and correct as far as we are able to ascertain from our sources. It is not intended to be an exhaustive or complete history of the subject. Please contact the Library for further reading materials on the topic.

Subject
Politics and Government>>Health
Transplantation of organs, tissues, etc.--Singapore
Health and medicine>>Medical science>>Surgery



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