Lung transplantation research center
Lung transplantation is one of the most complicated organ transplantations and that is why in many accredited centers around the world, physicians have not been able to successfully perform this operation with favorable outcome.
Our country is among the few countries in the region and in Asia that are pioneers in this field and at present this is the only active center for lung transplant in the country.
Lung transplantation team of Masih Daneshvari Hospital has been active since 7 years ago and due to the efforts of this team, in spite of the small number of lung donors, the number of patients with transplanted lungs is increasing. At first, number of lung transplants was 1 or 2 cases per year but this rate reached to 6 cases per year in 2006. Since early 2007, there have been 2 cases of lung transplant and both patients are in good condition. The successful outcome is due to the study and use of research results in this field. Also in 2006, transplantation of both lungs was performed in this center for the first time in Iran.
The goals of this center are as follows:
- Evaluation of different methods to protect the lungs of brain death patients and prevent problems regarding the lungs becoming unusable for transplant.
- Holding educational workshops for ICU nurses to improve quality of care for brain death patients
- Studying the results of different methods of harvest surgery, lung transplant surgery, prescription of immunosuppressive drugs, diagnostic and therapeutic methods for post transplant infections, recognizing factors responsible for rejection of the transplant, treatment of acute transplant rejection, treatment of chronic transplant rejection, lung transplantation anesthesia, complications of lung transplant drugs and replacing drugs with high rate of complications with those with less complications, studying the results of lung transplantation and methods for improving the results
- Training surgery, thoracic surgery, pulmonology, ICU, radiology, infectious diseases and anesthesia residents and fellows
Dr. Azizollah Abbasi, the head of the lung transplant research center stated that “performing 150 lung transplantations is one of the goals of this center in the next 5 years.” Lung transplantation in NRITLD was started in 1996 . So much efforts were made to meet the requirements for performing lung transplantation in this center and after performing a few transplant operations, university authorities decided to establish an organ procurement unit in this center. After the establishment of the procurement unit, number of lung transplants as well as cardiac transplants increased quickly most of which being successful. Educational and research activities in the field of lung transplant along with clinical practices, presenting articles, procuring organs, and etc helped in preparing the situation for the establishment of lung transplant research center. Its establishment was approved first by the university and then by the Ministry of Health. Increasing the number of lung transplants and performing 100 to 150 lung transplantations are of the goals of this center during the next 5 years. Among the other goals of this center are training surgery and thoracic surgery fellows and residents in terms of lung transplant, performing clinical researches for improving the outcome of transplant operation, performing basic science researches to upgrade the transplant knowledge and seeking help from people, governmental and non-governmental organizations in this regard.
Considering the interest of university and Health Ministry authorities and physicians of this center in lung transplant, we hope that this center can reach its goals in the near future.
Not having enough space, insufficient support of insurance companies, limitation of financial sources and high costs of taking care of patients after the transplant operation are among the problems of this center.
This center aims to prepare several clinical, basic science and experimental articles in the field of lung transplant. Also, educating physicians involved in the process of lung transplant, holding educational workshops, conferences, short term courses and sending researchers abroad to enroll in related courses are among the other objectives of this center.
Transplantation unit of Shaheed Beheshti University has 2 subunits:
1- Lung transplantation research center of this hospital started to work in the year 2000. Preparing the patients in need of lung transplant, evaluating the quality of the lungs of brain death patients for transplant and performing lung transplantation and providing post-operative cares are of the activities performed by this center. Establishment of lung transplant clinic is much more important than the lung transplantation itself. In this clinic, order, regularity and proper scheduling are important factors which are thoroughly followed. Transplant clinic is open on Sundays 1 pm and its aims are to find candidates of lung transplant and improve their physical and mental health status for the operation. There are 9 specialists of different fields of medicine working in this clinic (pulmonology, infectious diseases, rehabilitation, nutrition, psychology, cardiology, social work, and internal medicine). Since this unit is the only efficient lung transplantation unit in the country, a large number of patients requiring lung transplant are referred to this unit from all over the country.
2- The organ procurement unit of Masih Daneshvari Hospital (Shaheed Beheshti University) started to work in December 2004 with the aim of finding brain death patients and making necessary arrangements for organ donation. In spite of organ procurement, this unit is active in propagating the culture of organ donation. No other procurement unit in the country is comparable with this one in terms of its extensive activities. We have to emphasize that our aim is not to increase the number of harvests but to find all brain death cases in Shaheed Beheshti University Hospitals.
This unit has 2 major responsibilities:
A- Procuring organs for transplant
B- Cultural activities to propagate the culture of organ donation
Procuring the organ for transplant is a 13-phase process:
1- Detection
2- Primary visit
3- Obtaining consent for transfer
4- Finding the recipient
5- Transfer
6- Maintenance
7- Confirming the brain death
8- Obtaining the consent for harvest
9- Coordination
10- Harvesting
11- Transferring the deceased donor
12- Appreciation and participation in the funeral
13- Writing the harvest report
Cultural activities:
1- Holding educational courses for the personnel
2- Nafas (Breath) celebration
3- “Yavare Salamat’ project
4- “Safirane Zendegy” project
5- Preparing articles for “Naghl o Naghd” newspaper
Website:
Also, this unit has created a website as a symbol of utilizing technology for propagating the culture of organ donation among people. You can visit and obtain any information regarding organ donation at www.iran-ehda.com. Also, those interested in organ donation can ask any question in this regard. They can subscribe online and fill out the related forms. Their organ donation card along with educational pamphlets will be send to their address free of charge. There is a scrap book page in the site as well in which visitors can write down their points of view. By offering online subscription for organ donation cards, the number of candidates has increased several folds. Till August 21st, 2007, 69000 members have signed in and 5500 people have left us a note in the scrap book page.
According to Dr. Katayoon Najafizadeh, lung transplantation is among the hardest organ transplantations due to the control of post transplant complications.
One year ago two lungs transplantation was performed for the first time in Iran. The donor was a 19-year old male who was brain death due to car accident and his body organs such as heart, kidneys and lungs were donated to those in need after obtaining his family’s consent. His lungs were donated to Mahindokht Amani who was suffering from pulmonary disease for years. Dr. Najafizadeh is a member of the lung transplant research center who helped in the establishment of this center. She is also the head of the organ procurement unit. She considered lung transplant a costly procedure and stated that “…the transplant operation and the post operative care until discharge cost about 8 million Tomans…”. Some of the drugs required during this process are covered by the insurance companies but the problem is antibiotics and antifungal drugs because these patients have resistant infections which do not respond to usual drugs and new antibiotics and anti-fungal drugs are required which are expensive and should be covered by the governmental organizations.
