This fine-tuned assortment of medications keeps Wright from rejecting the lung she received more than ten years ago through Emory’s then-fledgling lung transplant program–the lung that has kept her alive far beyond what was expected, when she was suffering from emphysema so severe she couldn’t walk from one end of her house to the other without sitting down to rest.

Now fifty-nine, Wright was the second patient and the first woman to receive a lung transplant at Emory Hospital. She also is the program’s longest survivor.

Since its creation in 1993, Emory Hospital’s lung transplant program–now called the McKelvey Lung Transplantation Center–has performed just over one hundred transplants. As Georgia’s only lung transplant program, it has averaged about ten transplants a year.

“We are likely to be the only lung transplant program in the state for a while, due to the complexity of the procedure,” says McKelvey Center director Clint Lawrence, who has been with the program from its inception.

Spurred on by a $20 million gift in 2001 from Andrew McKelvey (the founder of TMP Worldwide, whose holdings include the Internet career portal and the addition of a third surgeon, Emory’s program is expanding rapidly.

“Hopefully, we can do the next hundred lung transplants in five years. I think that’s a realistic goal,” says surgeon David Vega. “Emory has made a concerted effort to make lung transplantation a priority, and a lot of energy is being put into the program. Of course, none of this would be possible without families agreeing and consenting to the donation of their loved ones’ organs during a time of real tragedy for them.”

About a thousand lung transplants are performed in the United States each year, with recipients chosen from a waiting list of about four thousand. Lung transplantation–which involves removing one or both diseased lungs and replacing them with donor organs that match in blood type and size–has become an important treatment for the end stage of several diseases, including emphysema (which accounts for about half of lung transplants), cystic fibrosis, pulmonary fibrosis, and pulmonary hypertension.

“Unlike kidney transplants, we don’t have anything like dialysis that can tide these patients over,” says McKelvey Scholar and transplant surgeon Seth Force (left). “These are patients who have a one- to two-year life expectancy. So their transplants are really lifesaving.”

Wright can attest to that. A smoker since high school, she quit after watching her father die of emphysema–but not until she had the disease, which causes shortness of breath and difficulty exhaling.

By the time she was placed on the transplant list in 1993, the forty-nine-year-old Wright was unable to go shopping, cook dinner, or walk to the basement because any exertion “winded me so badly.” She was put on portable oxygen and told that, without a transplant, she wouldn’t live to see fifty.

The call came on October 11, after just four months on the waiting list.

“I remember it was a Sunday evening and [my husband] Kent and I were watching the Braves in the World Series playoffs. The transplant coordinator called and told me they thought they had found a lung,” she says. “The last thing I remember was being taken in to surgery about eleven p.m. When I woke up, I was on the ventilator and it petrified me. I couldn’t talk.

I was panicking so much they put me back under. But I could tell the difference immediately. I was out of bed by that afternoon.”

Wright was home seventeen days later with a new left lung and within six months was feeling well enough to travel an to work in her antique booth at a nearby flea market.

“The thing that bothered me the most is that someone had to die for me to live,” said Wright, who knows only that her donor was eighteen or nineteen and died in an auto accident in North Georgia. “Then a nun said to me one day, ‘You don’t have any say over what happens.’ It was beyond my control. So I quit worrying.”

Wright now volunteers as a mentor for others who are waiting for or recovering from a lung transplant. “I just lost a lady I’ve been mentoring for three years. She passed away on Friday. She and I became really good friends, just e-mailing back and forth, sharing experiences. I’ve had such phenomenal luck and been blessed so much, but there’s no guarantee. Everyone’s body reacts totally differently.”

Lung recipients have the lowest five-year survival rate of any transplant recipients due to chronic rejection: 85 percent of recipients survive for one year after surgery, 71 percent for three years, and 54 percent for five years, according to national averages from the U.S. Scientific Registry’s 2000 annual report.

Accordingly, the research portion of the McKelvey Center is focused on developing new medical therapies for lung disorders–in hopes of warding off the need for transplants–and improving lung transplant patients’ outcomes following surgery.

“Patients are on an immunosuppression regimen for the rest of their lives or they will reject their new lungs,” says Force. “Even so, eventually the terminal airway becomes filled with scar tissue. This will happen to every lung transplant patient if they live long enough.”

Force came to Emory last summer from Barnes-Jewish Hospital at Washington University in St. Louis, one of the most active lung transplantation centers in the world. He was recruited to Emory as part of the program’s push to find a surgeon dedicated solely to thoracic sugery, especially lung transplants.

“There are huge resources here, almost like I’ve never seen before,” says Force, a boyishly enthusiastic thirty-six-year old. “In the past, lung transplant patients in Georgia were being sent to the University of Alabama at Birmingham or to Duke. But Emory’s program is ready to explode.”

The opportunity to be part of that expansion convinced Force to relocate to Emory with his wife, Sara, a high-risk obstetrician at Northside Hospital. As a new, first-time father to year-old Asher, Force is gratified when he is able to provide his patients extra years with their families and children.

“The most rewarding cases I’ve had are the patients who were in wheelchairs, basically incapacitated, a month or two away from dying, and then a month after the surgery they are up walking, youthful, with effervescent personalities,” he says. “After a transplant, there are no limits on your physical activity. There have been lung recipients who have run the Boston Marathon. They can sky dive or scuba dive. We just don’t want them walking into a smoke-filled room.”

Former smokers who wish to receive transplants must test nicotine-free for six months prior to the transplant. “Recidivism rates after the transplant are very low,” Force says.

Lung transplantation is a relatively new procedure, but there have been rapid improvements since the first successful single lung transplant was performed in 1983 in Toronto. Breakthroughs in tissue typing and immunosuppressant drugs have allowed for a larger number of organ transplants and a longer survival rate for transplant recipients.

“We now have a better idea of which lungs to accept and which to decline,” says Force, who must often make a long-distance determination. “For example, I’ll get a call that there is a set of lungs available in Pittsburgh, and I’ll get the story on the donor, a history, maybe an X-ray. Then I have to decide whether to accept the lungs. Last Friday, I accepted a set of lungs at seven in the morning and procurement took place at eleven that night–99 percent of lungs are taken from brain-dead donors where the heart is still beating, so they are trying to place all the organs. The heart is first, then the lungs, then the liver and kidneys.”

Only about a third of donor lungs are acceptable for implantation, due to disease, injury, or illness. “The lungs are the only organ open to the external environment,” Force says, “so they are at the mercy of anything coming in.”

After the lungs are selected and the donor is notified, speed is critical. The patient is prepped, the lungs are flown in, and the goal is to get the blood flowing through the fragile organs in as little time as possible–the average is three hours for a single lung transplant, six hours for a double.

Force has performed thirty lung transplants since coming to the McKelvey Center, including surgery on Emory’s hundredth recipient–forty-five-year-old Li-Chiung Brown.

Brown, whose lungs were damaged by a congenital birth defect that caused pulmonary hypertension (high blood pressure in the lungs), lost more than twenty pounds in the two years she was on the waiting list, dipping to a frail eighty pounds.

“I was so tiny and have a rare blood type, so a lot of people thought there was no hope,” says Brown, a native of Taiwan who now lives in Suwanee, Georgia, with her husband, Eric, and sixteen-year-old daughter, Annie. “I usually pray only for joy and for peace, but the pain was getting so bad, I prayed to God to either let me die or to give me a lung. . . .

“I wanted to see my daughter get married,” she says softly. “Then I am happy.”

Brown’s call came on October 28, 2003. “I was shaking on the way to the hospital,” says Brown. “Sometimes it was discouraging because the wait was so long, but I tried to keep my faith. I knew the day would arrive.”

The operation, a milestone for the transplant center, was filmed by the University health communications staff. On the tape, Force narrates the operation as he removes Brown’s diseased lungs, separates the donor lungs, and implants first the left, then the right. “We used to implant both at once,” he says. “Now, we split the lungs in half and the complication rate has come down considerably.”

After a month’s recovery, Brown returned home for the winter holidays. “Before, I pulled my oxygen tank behind me in a wagon all day,” Brown says. “Now, I feel free. Breathing is much, much better. I can cook my husband’s and daughter’s favorite dishes and walk on the treadmill about forty minutes every day.”

Next year, she is planning a trip back to Taiwan to visit her brother and best friend.

“These were all wishes I had, but now I can do them. I feel pretty lucky,” Brown says. “Lucky one hundred.”



© 2004 Emory University