Take a deep breath

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This article was published 01/04/2023 (920 days ago), so information in it may no longer be current.

Now that Winnipegger Rick Schmidt is on the official list for a new lung, he is waiting for one to become available.

When he gets that call, Schmidt and his wife, Sara Jane, will head straight to the airport for an air ambulance flight to Edmonton.

At the same time, the transplant team in Edmonton will start getting ready to receive both Schmidt and the donated lung.

It’s an elaborate and careful choreography, said respirologist Dr. Justin Weinkauf, 49, who has been part of the lung transplant program at the University of Alberta hospital since 2002.

The hospital is one of four in Canada that does lung transplants; the other three are in Montreal, Toronto and Vancouver. Altogether, they do between 250 to 300 lung transplants a year, with 55 to 70 taking place in Edmonton, which serves the prairie provinces.

Since starting with the program, Weinkauf estimates he has been involved in about 800 lung transplants as part of the postoperative recovery team.

When Schmidt, who has Idiopathic pulmonary fibrosis (IPF), arrives at the hospital, he will immediately be prepped for the surgery. The process takes about six hours. At the same time, the donated lungs are taken from the donor and then, if not procured locally, flown to that Alberta city.

“We want them out of the donor’s body and into the patient’s body within eight hours,” Weinkauf said of what’s called ischemic time — how long an organ can be outside a human body without blood and oxygen flow.

“The clock starts ticking the moment the lungs leave the donor,” he said.

After arriving in the operating room, Schmidt will be anesthetized and may be put on a heart-lung breathing machine. Then surgeons then make incisions in his chest — what’s called a clamshell thoracotomy — and pry apart his ribs to expose the lungs.

“It’s a very large and delicate surgery, taking between six to eight hours and involving seven or eight people,” said Weinkauf.

After the operation, Schmidt will be transferred to the intensive care unit where he will remain sedated and continue on a breathing machine for 24 to 48 hours or longer.

That’s where Weinkauf’s work begins, taking care of patients after their surgery.

“We do very close monitoring for that period,” he said, noting between 30 to 40 per cent of patients experience infections or rejection in the first few weeks.

At that point, the rejection is fairly straightforward to treat and doesn’t necessarily affect the long-term outcome, he said.

After two to three days, Schmidt will be taken off the machines and begin breathing on his own. He will then spend two to three weeks in hospital in Edmonton before being transferred to Health Sciences Centre in Winnipeg to continue his recovery.

The median survival rate for lung transplant patients is 10 years, Weinkauf said, noting he knows one patient who is going on 30 years with new lungs.

“It’s not common, but it does happen,” he said.

While there are various factors that contribute to whether or not the transplant succeeds, a major one is the post-transplant work of patients.

“They need to strictly adhere to a regimen of taking their many medications, remaining active and living a healthy lifestyle,” Weinkauf said, noting it’s a lifelong commitment.

“The bond between transplant patients and their doctors is stronger than marriage. Your marriage might end, but your relationship with the transplant team is lifelong.”

While the success rate is very good, the process is not without risk. One per cent of patients don’t survive the surgery, and 10 per cent die within the first year.

When it doesn’t work out, it’s heartbreaking, Weinkauf said.

“It’s really hard and painful when someone dies.”

But knowing most patients will go on to live good and high-quality lives after transplantation keeps him going.

“To see someone facing death get their life back through a transplant, and then to watch them see their family grow, celebrate birthdays and anniversaries and other life events, it’s absolutely amazing to witness those miracles,” he said.

And that’s all because of teamwork, he said.

“The best part of my work is being part of the transplant team. Each one has an important role to play, including the patient.”

And when the team saves a life, “it’s like winning a championship,” he added.

As for Schmidt, he’s less worried about the surgery than about the time after the operation.

“I’ve had emergency triple heart bypass surgery,” he said of a previous surgical experience. “The transplant is more substantial, but I’ve already seen the warm-up band.”

In fact, the bypass is the reason he’s only getting one lung replaced.

“They don’t want to do anything to mess up the bypass, so they are leaving that side alone,” he said.

What’s mostly on his mind is the time after the transplant, such as all the pills he will have to take every day, potential bad reactions to medications and the ever-present threat of rejection. Yet he feels ready to go, whenever the call comes.

“I’m not as in good shape as I used to be, but I expect to do well,” he said. “I think a positive attitude is important. And I know I am in good hands.”

To become an organ donor, visit www.signupforlife.ca.