Coronavirus: Fears grow of a lung transplant surge

Greg Snell is among a small but elite group of 12 Australian surgeons who are capable of carrying out a double-lung transplant.

Greg Snell outside the Alfred hospital in Melbourne. Picture: Aaron Francis

Greg Snell is among a small but elite group of 12 Australian surgeons who are capable of carrying out one of the most delicate operations known to medicine — a double-lung transplant.

The invasive 12-hour procedure, in which a surgeon’s scalpel slices open a patient’s chest, is a desperate measure reserved for people suffering from irreversible lung damage. 

About 220 double-lung transplants are successfully completed across four Australian hospitals each year, but as COVID-19 tightens its grip on Victoria, doctors fear they will soon be dealing with a spike in the number of critically ill people needing new lungs.

“It’s a frightening prospect,” explains Professor Snell, head of The Alfred hospital’s lung transplant program in Melbourne. “We have to be prepared for an increase of more than 40 cases.”

Victoria’s virus trajectory could mean there will be people with COVID-19 whose only hope of survival will be a surgeon who can replace their diseased lungs.

“The referrals are slow coming through but there’s definitely a proportion of people who will have permanent damage, based on what we know from overseas,” Professor Snell said.

He said it was possible Victoria’s second wave of COVID-19 could lead to a 15 per cent spike in people needing transplants over the coming years.

“On the back of the first wave, we didn’t have any specific COVID-19 referrals (for transplantation),” he said, “but this time it’s different.”

Monique Malouf, who performed 37 double-lung transplants at Sydney’s St Vincent’s Clinic last year, said she agreed with Professor Snell’s assessment.

In Sydney, Dr Malouf said her team breathed a cautious sigh of relief once the first COVID wave passed without a surge in community-­acquired infections.

“We’ve had no patients (needing a transplant) at this stage,” she said. “I would be wrong to say it won’t happen, but we haven’t reached that point yet.”

The surface area of a healthy person’s lungs is about the size of a tennis court, but with COVID-19, an infected person’s lungs can contract to the size of a table tennis court. “Essentially, the lung is supposed to be a sponge and what COVID will do is concrete the lungs,” Professor Snell said.

“You just don’t have enough surface area so you end up with a little box of concrete rather than big spongy lungs.”

The only way to save those patients’ lives would be to replace their destroyed lungs with those of a matching donor’s.

A key issue for the nation’s lung-transplant surgeons is the well-documented fact that COVID’s long-term effects on the lungs largely remain a mystery.

“It’s still so early,” Dr Malouf said. “We just don’t know the long-term effects so I can see that (transplants) may happen.”

Lung donations are down 20 per cent compared to this time last year; further complicating what is literally a matter of life-and-death are border closures which make it incredibly difficult for doctors to fly organs between the major capitals. “It’s getting pretty tight at the moment,” Professor Snell said. “At any moment, we could be shut down from doing transplants all together.”