COVID-19 fuelling an increase in double-lung transplants in B.C., specialist says

COVID-19 is contributing to an increase in the number of double-lung transplants in the province, with a record number of the surgeries being performed in British Columbia over the past two years.

A total of 107 British Columbians have had double-lung transplants during the past two years — nine involving lung damage related to COVID-19 since April, according to the head of the transplant program.

Last year, B.C. set a record for double-lung transplants with 55, up from the previous high of 52 in 2017.

So far this year (end of October 2021), there have been 52 double-lung transplants, and that's expected to rise to about 60 by years end, according to Dr. John Yee, the director of the lung transplant program at Vancouver General Hospital.

The number of lung transplants in B.C. per year has more than doubled since 2014 when there were 24. 

Yee says the majority of the lung transplant cases in B.C. involve conditions like pulmonary fibrosis or scarring of the lungs. He says the number of transplants is rising due to more awareness, demand and the rise of new diseases.

The most aggressive of those is COVID-19. 

"In terms of the volume of people that we are seeing and the ferocity with which the lung damage occurs — this is quite unprecedented," said Yee.

"There are virtually no diseases that can accelerate lung damage as quickly as we've seen with COVID."

He says coronavirus is leaving some people so damaged that despite best efforts to heal their lungs for months on life support — they are left with no option but to remove and replace them.

Eight of the nine people who had double lung transplants due to COVID were aged between 30 and 50 and "healthy," he said.

Yee says two of the nine people were long-haul COVID patients, and one had previous lung damage but once they contracted the virus, it pushed that damage so far the patient would have died.

He says all nine were people who worked with the public and were unvaccinated at the time they contracted COVID, as it was early in the pandemic and vaccines were not yet available.

Brenda Brown, the president of the Canadian Transplant Association, says she is surprised there were nine cases in B.C. alone due to COVID, but she's pleased the organs were available.

There's always a concern, given waiting lists, that any new disease that attacks the lungs puts pressures on the system.

In 2020, there were more than 4,500 Canadians in need of organ transplants; 260 of them died waiting for suitable donor organs. There are currently about 4,800 people waiting for organs, according to Brown.

But Brown says lungs are not in the highest demand; 75 per cent of the people on the wait-list are waiting for a kidney, liver or pancreas.

"Nine cases is still a small percentage, and hopefully we can slow that down with vaccinations," said Brown.

COVID's toll

COVID-diseased lungs become scarred by viral and bacterial pneumonia and filled with fluid and pus, eventually the tissue becomes so stiff and "leathery" they lose their elasticity they become unable to inflate normally, Yee said.

The patient ends up on life support for months in an effort to allow them to heal, and that, over time, can compound the damage.

"All of the patients we are seeing are very debilitated because they've been bed-bound for months — many unconscious due to the need for sedation," said Yee. "The quality of life would be horrendous."

Yee says the patients he's worked on were left with no other choice as they were unable to work, walk or live without remaining on life support or getting a double lung transplant.

Most were first placed on an ECMO machine to oxygenate their blood, as a last ditch effort before turning to transplantation. An ECMO or extracorporeal membrane oxygenation machine is used to support the heart and lungs by oxygenating the blood.

Patients whose lungs are destroyed by COVID have a much longer rehabilitation process than other lung transplant survivors who can recover in weeks. Those who have had COVID are facing a minimum of six months — due to the time they generally have had to spend on life support, according to Yee.

Yee says at last check, there have been 12 lung transplants in Canada due to COVID-19, with nine in B.C., three in Ontario — at either Toronto General Hospital or the Hospital for Sick Children and none at the other transplant centres at the Centre hospitalier de l'Université de Montréal, Hôpital Notre-Dame in Quebec, at the Health Sciences Centre in Winnipeg, Man., and the University of Alberta Hospital in Edmonton.

In 2014, 89 per cent of the 220 lung transplants performed in Canada involved the replacement of both lungs, according to the Canadian Institute for Health Information (CIHI).

Five years later in 2019, a total of 404 lung transplants were performed in Canada and 237 people remained on a waiting list. 

Of those waiting, 41 died, according to the most current data available in the Annual Statistics on Organ Replacement in Canada report from CIHI.

While COVID-related transplants still remain rare, with only a dozen so far in Canada, the aggressive nature of the virus does concern doctors.

"I've never seen anything like this that affects otherwise completely normal healthy people to knock them down so hard and so severely and end up permanently destroying their lungs," said Yee.