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12 days in Wuxi: lung transplants up close

Wuxi is an old city in China’s Jiangsu province west of Shanghai, with a population of around 6 million. It is known for the scenic Taihu Lake and the giant Ling Shan Buddha. It is also known for the 2,100-bed Wuxi People’s Hospital, whose lung transplant team has performed more than half of China’s lung transplants.

Upon arrival at the Shanghai Pudong International Airport, I and two other physicians from the National Kidney and Transplant Institute traveled by car for two and a half hours, reaching Wuxi late at night but going straight to one of the operating rooms of the Wuxi People’s Hospital to watch a double-lung transplant for terminal emphysema. (The lungs resembled, for want of a better term, cotton candy.)

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The surgeon was professor Chen Jingyu, who started lung transplantation in China in 2002 after training at the Toronto General Hospital in Canada. Seventeen years later, the Wuxi People’s Hospital claims to be among the Top 3 lung transplant centers in the world.

In surgery, it is not about who is the best but who has done the most. Professor Chen performs single, double-lung and combined heart-lung transplantations for various types of terminal lung diseases not amenable by conventional surgery. And he does this almost every day, in Wuxi as well as in Hefei city in neighboring Anhui province, to Chengdu in southwestern Sichuan province, at least when we were there.

He is also the chief lung transplant surgeon of another of the three major lung transplant centers in China, the China-Japan Friendship Hospital in Beijing. His team has advanced the techniques of lung transplantation in 30 hospitals in 10 cities and provinces in China, so that he has become known as the No. 1 lung transplant surgeon in China. I was witness to the many doctors and nurses from all over China who spent time in Wuxi training with him. I also saw the numerous lung transplant patients who looked normal, but like St. Thomas the doubter, I inspected the operative scars of some of them.

The surgical technique of lung transplantation has not drastically changed from the ones we performed in Cambridge, England, more than 25 years ago, when I was training there. But now, there are better and stronger antirejection drugs and more technology-dependent diagnostic examinations.

Basically, when a lung from another person is transplanted, the body detects the lung as foreign and rejects it, thus the need for powerful drugs to suppress this reaction. These immunosuppressive drugs may lead to a weakened immune response that predisposes the patient to all kinds of infections, thus a balance is needed to find what I call the Goldilocks zone—neither too strong that would lead to infection, nor too weak that the donor lung is rejected.

Emphysema remains the top indication for lung transplantation in Wuxi, which is not surprising. Cigarettes are readily available, even in the hotel where we stayed. I saw used cigarette butts in many trash cans. In restaurants, the smell of cigarette smoke wafted across the dining area. Even in the hospital, there are specially built outdoor huts labeled smoking areas.

One kind of lung disease I saw in China was pneumoconiosis, an occupational hazard among industrial and agricultural workers, particularly coal miners, who inhale dust. Professor Chen, who is also a deputy to the National People’s Congress, has introduced reforms to diagnose this condition earlier so that effective treatment can be carried out.

There have also been horror stories of organs taken from executed prisoners, but in 2015, China abolished this practice.

China has become a sort of pariah in the international transplantation community because of this—a perception that persists up to this day despite the ban.

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One problem of transporting donor lungs is the availability of commercial flights for transportation to Wuxi and also the road traffic; there have been stories of missed flights and blocked emergency road lanes, causing delays in transplanting lungs where time is of the essence. This has led professor Chen to institute the green lane policy, which allows donor organs priority in airplane flights and road traffic right of way. His team also developed a preservation solution that would extend the life of donor lungs from the usual four to six hours to nearly eight hours.

The American medical researcher Lewis Thomas called this “halfway technology,” the kind of technology “designed to make up for disease, or to postpone death”—technology that is expensive and temporary, “highly sophisticated and profoundly primitive.” This is in contrast to the technology that is often taken for granted, “the real high technology of medicine,” or a genuine understanding of the mechanisms of disease; Thomas’ example is pulmonary tuberculosis, which used to be treated by surgical means in specialized hospitals until the discovery of streptomycin.

That brings us to the issue of preventing chronic lung diseases—by stopping smoking and addressing the more difficult and larger problem of air pollution. This “real high technology in medicine” also includes vaccines for measles and polio.

On the day we left Wuxi, three more lung transplants were scheduled, but one had to be canceled because of the poor quality of the donor lungs. Both patients eventually had a successful outcome.

Meanwhile, for those already afflicted with the ravages of end-stage lung disease, and for those born with incurable genetically derived lung disease, there is hope in lung transplantation.

Jose Luis J. Danguilan, MD, a thoracic surgeon, is former executive director of the Lung Center of the Philippines.

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TAGS: 12 days, China, Commentary, Jose Luis J. Danguilan, lung transplant, Wuxi
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