The Republic is about to get its long-awaited lung transplant facility. Éibhir Mulqueen reports
A lung transplant programme is to begin in the Mater Hospital, Dublin, next month, completing the provision of solid organ transplantation services in the Republic, according to Freddie Wood, director of the National Heart Lung Transplant Programme.
Currently the lung programme is run by the Freeman Hospital in Newcastle, England, which harvests the lungs donated in the Republic and carries out the operations for Irish people on a waiting list. Last year 17 lungs were harvested.
"To do lung you need a lot of additional resources and staffing. As a consequence of that, it has taken this length of time to put in place.
"It has required considerable funding from the Department of Health and Children, and this was finally agreed in 1997," Wood says.
Since the heart transplantation programme started in 1985, more than 230 operations have been carried out.
About 170 are receiving long-term care and last month the longest surviving heart transplant patient celebrated his 18th anniversary of the operation.
The lung programme will begin with the harvesting function being taken over by the Mater Hospital-based team, in what Wood describes as "the run-in phase to complete repatriation of the programme from Newcastle".
"It is an ongoing programme. We anticipate the organs we will harvest to be passed onto Newcastle and then after a period of time, when we are comfortable with harvesting, we will transplant here," he says.
Over a three-year period, he hopes that 25 lungs will be harvested annually, with between 10 and 15 of them being used in transplant operations.
Within two years, he hopes to do up to six lung transplant operations.
In broad terms, the heart and lung operations are similar: the patients are fragile and because immuno-suppressant drugs are used to prevent rejection, the patients are more difficult to manage.
"What people forget about lungs is that, other than your skin, it is the only organ in contact with the environment. Patients are susceptible to infection in the months after the operation."
The establishment of the lung transplant centre will cost around €7 million and will involve the building of a theatre and post-transplant recovery unit.
"A lot of people say this is an awful lot of money for a small amount of operations but what has happened is we have identified all the acute and chronic lung failure cases.
"We are assessing 80 a year. At least half or more are being offered alternative medical therapies that were not available up to now and do not involve transplantation.
"To date, we have some 200 such patients all being offered some form of treatment. We have addressed a huge lack of care for this type of terminally ill patient."
Typically, half of the people requiring lung transplants suffer lung failure as a result of cystic fibrosis.
The other half consists of people suffering from emphysema, as a result of smoking or some other pollutant, and people with idiopathic pulmonary fibrosis.
The hospital mortality ranges between 15 per cent and 20 per cent, higher than heart transplant operations where the mortality rate is between 5 per cent and 12 per cent, depending on what previous surgery the patient has had.
Wood says that in both heart and lung transplantations, there are two key issues for those waiting. One is the blood group of the recipient and the donor, and the other is the size of the heart and the lungs.
"A lot of them we will not be able to match because of a blood group mis-match or because of a size mis-match.
"So, a considerable proportion of what would be offered cannot be utilised."
It is mostly men waiting for a heart donation and they typically weigh between 80 and 90 kilos. Organs from a woman who weighs 60 kilos cannot be used in those circumstances.
Conversely, if the lungs, for example, are too big, "you cannot squash them into somebody who is smaller".
Multi-organ donation rates in the Republic are high - fourth in Europe and double the British rate. Up to 27 hearts are harvested annually.
"Of the hearts that we harvest we would use about 15 to 18 here and the rest we export.
"That is enough to supply us with the minimum number of what we need for those waiting"
Countries such as Austria and Belgium have higher rates because they have a law which stipulates that one has to opt out of organ donation.
"You are always going to get a percentage of patients waiting, where we do not get a suitable organ for them. Consequently, there is significant pressure for more organs to be donated."
Organ donation depends on the agreement of next-of-kin following the death of a person.
"If you take someone like myself who has four kids, all adults, and my wife, they would have a family conference about it.
"It only takes one dissenting voice who is not quite comfortable with it. If one in a family is not quite comfortable, then nobody is going to force the issue."
He favours a system similar to the Spanish one where each hospital has a dedicated senior nurse responsible for organ donation and counselling relatives in relation to organ donation.
"There is no doubt that that system here would increase the organ donation rate, which is already excellent," he says.
He describes the European Heart and Lung Transplant Games as a wonderful event which illustrates the turnaround in the participants' health.
About 95 per cent of heart patients have a year to live before their transplant operation.
"The lung ones are normally oxygen dependent and 95 per cent have less than two years to live," he says.