Thoracic surgeon György Lang thought he had reached the peak of his career in 2017 when he successfully climbed Kilimanjaro, the highest peak in Africa, with 12 former lung transplant patients of his. But that was before 2020 and the coronavirus pandemic, when the acclaimed Hungarian surgeon performed the world’s first lung transplant on a COVID-19 patient at the AKH (Vienna General Hospital) in May – stretching the boundaries of the possible.
“I was looking into the void and saw the meaning of life,” the 58-year-old reflected of his climb to the 5,895-meter peak. “I was with people who a few years earlier were destined to die and were saved thanks to organs from people who did die. This was mind-boggling.”
Organ transplantation is a complicated business – “like replacing a car part, except with the engine running,” jokes Lang, who leads about a quarter of the 120 lung transplant operations performed annually in Austria.
Where It All Began
It all began in 2003, when his superior at a Hungarian hospital proposed that he apply for a scholarship in Vienna to learn how to perform lung transplants, something that had never been done in Hungary, despite the country’s pioneering work with kidney, liver and heart procedures. After his initial stint as a fellow, Lang has lived in Vienna off and on since 2006. He performed his first lung transplantation in 2003 at AKH, and after years of bureaucratic wrangling got to perform Hungary’s first lung transplant in in 2015. He has trained a new generation of thoracic surgeons there and, Hungary, is a specialist in through the twists of both fate and health politics, was forced to give up his post in Budapest in 2019.
The lucky winner were Austria’s lung patients and the medical students, who now had Professor Lang full-time.
“I feel at home in Vienna and always have,” he says while sipping coffee on a recent September evening at – where else? – the Budapest Bistro on Pilgramgasse. “Having grown up in western Hungary near the Austrian border, my father spoke to me in German from an early age.”
Giving the Gift of Life
A lung transplant requires the cooperation of 50 to 100 professionals. When a patient with healthy lungs dies somewhere, a group of surgeons needs to quickly perform an operation to remove organs that could be life savers for the terminally ill. A lung can only survive for six to eight hours outside the body, so time and clockwork cooperation are of the essence. The lung, in a cooling box, is transported by airplane or helicopter to Vienna, while the recipient undergoes the preliminary preparation for surgery. But the major work stays on hold until the plane lands at Schwechat. When the doctors are certain that the lungs will make it to the operating theater, they open the recipient’s thorax and connect an external, artificial lung so that the body’s oxygen supply is ensured during the operation.
They then remove the diseased lung, timing the procedures so that they reach this stage just as the replacement lung arrives at the hospital. They then insert the new lung, connecting it with vessels and airways. Once they see it is functional, they disconnect the patient from the artificial respirator. Sound complicated? It is. Even in the best of times, the operation takes three surgeons, three anesthesiologists and their support staff about six hours to perform.
Unlike some of the other organs, such as the kidney or the heart, artificial lungs do not yet exist for use beyond a couple of months. Therefore, a transplant is the only option for patients with advanced lung disease that’s not responding to other methods of treatment and who have a life expectancy of a few months to a couple of years. The lungs of these patients, typically suffering from complex conditions such as pulmonary hypertension or cystic fibrosis, operate at around 20% of their capacity, and the patients require an extra oxygen supply to survive.
The Virus & the Wonder
Enter COVID-19, a disease that sometimes attacks, and in rare cases, destroys the lung, which makes a possible operation infinitely more complex: Not only does it need to be performed in protected suits in which the operating team has difficulty moving and can barely hear each other, the patient’s immune system is typically already so compromised that lowering their immune defenses – a normal step during organ transplant to avoid the new organ being rejected by the body – could be fatal.
So no wonder that only three such operations have been performed globally so far – the first at AKH by Lang. The patient, as reported in aLancet article, was a 45-year-old previously healthy woman from Klagenfurt in Carinthia, whose lungs were destroyed by COVID-19. She is recovering well.
Which surely is the meaning of life.
