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Andrew Currie had just hours to live awaiting a lung transplant when a pair became available.
But the lungs came with a catch.
The donor had the Hepatitis C Virus (HCV), and the lungs were infected with it. Though a
simple drug regimen had been recently found to cure the virus in HCV patients, the treatment had never been applied in the case of transmission through lung transplant.
Andrew, 44, and his family were faced with a choice: take the lungs and risk getting the virus, or reject them and die.
"I never even thought of saying no," the father of three recalls. "I wanted to live and I didn't care if I had an extra drug to take post-transplant."
Dr. Marcelo Cypel, lung transplant surgeon at Toronto General Hospital, a multidisciplinary team, and Andrew made the decision to proceed with the transplant and wheeled Andrew in for surgery.
Three months later, Andrew was healthy and cured of Hepatitis C, offering hope that other lives could be saved, even with higher-risk donor lungs.
Behind-the-scenes of a life-saving decision
"Very little that we do in transplantation is a single-person decision," says Dr. Lianne Singer, Medical Director of the Lung Transplant Program.
"In this case there were the surgeons, the respirologists that were looking after the patient, the liver team led by Dr. Les Lilly, and the infectious diseases team led by Dr. Atul Humar. It was all the key experts getting together to talk about what we would recommend to the patient and having to make that decision fast."
The multi-disciplinary group agreed that the potential benefits of transplant – even with the virus – outweighed the option of waiting for a healthier organ.
"Andrew's life was measured in hours at that time," explains Dr. Cypel, "I think in that situation, many of us would have accepted the donor lungs for the chance to live."
The donor lungs were placed on the Toronto Ex Vivo Lung Perfusion (EVLP) System for six hours. EVLP allows donor lungs to be kept alive outside of the body, in order to be assessed, treated and repaired before being transplanted into a patient.
Though the system didn't clear the Hepatitis C, it ensured the lungs were otherwise healthy for transplant.
While Andrew's surgery took place, his wife, Lisa, asked their whole family to pray for him.
"For us, it's as if God put everything into place," she says. "Not everyone would have been willing to take this chance on Andrew.
"If the team at Toronto General Hospital hadn't been here for us, what would have happened?"
This lung transplant was another step in a long journey for the Currie family.
Andrew was diagnosed with Idiopathic Pulmonary Fibrosis (IPF) in 2009. IPF is a disease of scarring in the lungs, which gets worse over time. The most effective "cure" is a lung transplant.
Andrew's family, including two of his three children, had moved to the Toronto area from New Brunswick to support him as he waited for transplant.
He received his first lung transplant in 2012. The recovery, as Andrew remembers it "didn't go so well."
"For reasons that we don't always fully understand, some lung transplants don't work as well as others," says Dr. Singer.
The family returned to New Brunswick, but when Andrew's condition started to deteriorate in 2014, the Curries returned to Toronto to wait for a second transplant.
After the second transplant, Andrew tested positive for Hepatitis C. He started a three-month treatment after his transplant, and was cured from the virus within three months.
"All I had to do was take a pill a day for 12 weeks," he says. "There were no side effects or anything."
Living proof of a new hope
Making tough decisions such as the one in Andrew's case is part of the job when it comes to transplant surgery, says Dr. Cypel.
"We make judgements based on what we know and whether we can save someone," he says. "The good thing about this decision is the impact – it could help us open a new large source of donors for lung transplants."
Currently, lungs infected with Hepatitis C are discarded. While there are studies that are examining the use of HCV-infected livers in transplant, intentional lung transplantation using HCV-positive donors to HCV-negative recipients has not been assessed in lung transplantation.
Andrew's case was reported in detail last month in the
American Journal of Transplantation.
"Andrew demonstrated that this is possible and that really encouraged us to take the next step," says Dr. Cypel.
UHN will soon launch the first clinical trial to test the intentional lung transplantation using HCV-positive donors to HCV-negative recipients in about 20 patients awaiting lung transplant.
"It has an impact on other patients because if we can start using these lungs then we may have an additional thousand donors a year in North America," Dr. Cypel says. "That's huge."
A new life
While the outcome of this transplant is far-reaching, it has also made a dramatic difference for Andrew.
"I'm able to enjoy everything more," he says. "I'm able to walk around, I don't need the help of an oxygen tank to breathe and I'm not sick all the time."
He has been able to spend time with his children as they grow into young adults, and he and Lisa are expecting their first grandchild in early 2017.
"It is wonderful just to know that we had taken this calculated risk to save Andrew's life and things have gone exactly as we had hoped," says Dr. Singer.
"He's finally getting the benefits of the lung transplant that he came to us for."