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The lungs are one of the main organs in our body system. They run the respiratory system and help us humans to breathe and respire, allowing us to gain energy and take in oxygen.

A common organ failure is lung failure (also known as respiratory failure). Normally, this occurs when air movement is limited, less oxygen is taken in or less carbon dioxide is released (Kahn, “Chronic Respiratory Failure: Causes, Symptoms, Diagnosis.”) Other causes include “smoking, drug or alcohol overdose, conditions that affect the nerves and muscles that control breathing (e.g. stroke), and lung diseases like COPD” (“Respiratory Failure”).

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There are two types of lung failure: “Type 1 respiratory failure is when the blood oxygen is low and the carbon dioxide is normal or low. Type 2 respiratory failure is when the blood oxygen is low and the carbon dioxide is high” (Rull, “Respiratory Failure – Causes”). The two types share common causes like COPD and acute respiratory distress syndrome (ARDS). The diagram (see Fig. 1) below clearly shows the difference between a healthy lung and a lung with various conditions that result in lung failure.

 

 

Fig. 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Many symptoms of lung failure include “difficulty in breathing (including shortness of breath and rapid breathing), coughing up mucus and blood, wheezing, bluish tint to the skin, lips or fingernails, fatigue, anxiety and confusion” (Kahn, “Chronic Respiratory Failure: Causes, Symptoms, Diagnosis.”). Shortness of breath could happen when the patient exerts themselves too much. Tiredness could be a sign of the amount of oxygen that is getting to the body’s organs. Bluish lips could be a result of cyanosis. Patients could also experience fits or seizures (Rull, “Respiratory Failure – Symptoms”). According to “Respiratory Failure”, chronic lung failure patients could have an inconsistent heart beat pattern or may even fall into a coma. Diseases such as Chronic Obstructive Pulmonary Disease (COPD), Pulmonary Fibrosis and Cystic Fibrosis are a few examples that cause the failure of the lungs (“Lung Transplant”).

 

In order to solve this issue of lung failure, a current solution is lung transplant. This means the patient’s unhealthy lung is replaced by a donor’s healthy lung. The replacement is surgically done by a specialized surgeon. Depending on the severity of the lungs, the doctor may ask the patient to replace one lung or even both. It is known to improve the patient’s health and quality of life (“Lung Transplant”). In most cases, “the healthy lung is from a deceased donor” (“Lung Transplantation”). Before the transplant takes place, a series of blood tests are taken to check the condition of the lungs, heart, liver and kidneys. The recipients (those receiving the transplant) are to be substance-free at least one year before the transplant. The average waiting time for a lung transplant is about 4 months (“Understanding the Organ Transplant Waiting List”). The lung is stored in a preservative solution, which is mixed with a cold solution. This mixture is flushed on the lungs, cooling them and removing blood from the pulmonary vascular bed. They are transported in a temperature of 4 degrees Celsius to 8 degrees Celsius (Cypel, “Lung Transplantation: Donor Lung Preservation”). After the surgery, the recipients are required to take all the medications given to them by the doctor (they are given immunosuppressive drugs). Immunosuppressive drugs are used after the transplant to keep the body from rejecting the lungs. Antibiotics, cyclosporine, tacrolimus and anti-fungal medications are examples of immunosuppressive drugs (“Immunosuppressant Medications After Lung Transplantation”). The survival of patients with lung transplant varies from about a year to 10 years. The survival solely depends on how the patient takes care of themselves and lead their lifestyle. An example of lung transplant can be seen below in Fig. 2.

 

 

fig. 2

 

The lung transplant has its own benefits and drawbacks.

 

The benefits are that it improves patients’ health, lifestyle and is able to live longer. If patients have obtained a healthy set of lungs, they are not at risk of developing cystic fibrosis. They are able to breathe more easily. They are able to participate in challenging physical activities and they are able to continue with their previous lifestyle (before their lungs failed).

 

These are the following drawbacks. The organ could “reject” the lungs (e.g. BOS – Bronchiolitis Obliterans Syndrome), meaning that if the new pair of lungs don’t receive immunity from the body, there is also a risk of developing infections that could affect the transplanted lungs and the surgically connected airways could affect blood flow, causing airway problems. Although cystic fibrosis may not occur in the lungs, they could happen in other organs in the body (“Weighing the Benefits and Risks of a Lung Transplant”). The medications taken before and after the transplant (called immunosuppressive drugs) pose many threats, much worse than those of the actual transplant. The patient is at risk of developing cancer, diabetes, high blood pressure and osteoporosis (“Lung Transplant – Risks”).

 

“The solution is an effective treatment for disease that had destroyed the lungs function to operate” (Khatri, “Lung Transplant”). If successful, life after a lung transplant is normal. For instance, one lady, named Lisa Slater, had a lung transplant when she was 15. She had just turned 31 this year. She claimed that after the transplant she had felt drowsy, however was back on her feet by that afternoon (Slater, “Life after a Lung Transplant”).

 

Amongst the many solutions for lung failure, the most effective is indeed getting a lung transplant. Other types of solutions include: oxygen therapy, tracheostomy and the ventilator. Oxygen therapy provides extra oxygen through a nasal cannula (like a tube), this can be seen below in Fig. 3. This solution is uncomfortable and the patient is unable to lead a normal life (or lifestyle), as a container has to be carried around with the tube. Tracheostomy involves the surgical implantation of a breathing device on the front of your neck (a hole is made in order to insert the device) (see Fig. 4). This also makes the person lose their chance of leading a normal life, and are at risk of losing their life while the hole is made surgically. Ventilator is a huge machine that supports the breathing of the patient, however the patient is bed-ridden (see Fig. 5), and is unable to do much while on the ventilator (“Respiratory Failure”).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The lung transplant survival rates also indicate its effectiveness. For example, in the US (for adults) the one month survival rate is about 97%, for one year it is about 88% and for three years it is about 69% (…1).  Comparing all the one year survival statistics, oxygen therapy survival rates (for adults) are about 88% in one year (…4), for tracheostomy is it about 65% (…5) and for ventilator it is about 62% (…6). Fig. 6 shows the survival rates of a lung transplant patient along with the number of years they can survive. This graph shows how the survival rates have risen over the years, which gives an indication that they will rise in the future (see Fig. 7). This shows that the lung transplant solution is more effective than the other solutions for respiratory failure.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part 2

A lung transplant is a viable solution for lung failure, however it does include ethical issues regarding the shortage of lungs. Additionally, there are ethical issues behind who gives consent for giving up their lungs. Every year, about 1656 recipients are shortlisted for a lung transplant, unfortunately due to the waiting time of about 4 to 5 months, about half of those on the lost die, as they are unable to survive too long to wait (…5). Due to the shortage of organs, there is an increase in organ trade. This is where the organs are “illegally obtained and traded for transplantation” (…3). They are obtained by killing innocent children and adults (which occur mainly in developing countries like China and India). For example, one schoolboy is the US was killed on his way back home and his lungs (and other organs) were not found inside his body after an autopsy (months after his death) (…6). These unethical practices are prevalent around the world with about “10,000 black market operations, involving human lungs, take place annually” (…4). The lungs are one of the organs distributed around the world illegally, costing about $50,000 in the black market. A lung transplant normally costs about $560,000 (…7). Even though it is unethical, many people who purchase these ‘black market lungs’ are those who can’t afford the tremendous cost of a transplant, and resort to such markets to save their loved ones. Other reasons why people invest in organ trade is to pay off debt, as they owe money to someone else. People also gain lots of money by selling lungs and other organs. In many hospitals, the donor has to agree directly for a lung transplant. Normally during cadaveric organ donation, once a person dies (natural causes, accident etc.) the organs are allowed to be donated only if consented. Consent is very important, as people may have religious beliefs or not want their organs to be used for donation (…2). A shocking example would be that prisoners (who have been given the death sentence) donate most of their organs, even if they haven’t given consent. The Chinese government admitted that 95% of donated organs were from executed prisoners (…1). In conclusion, the lung transplant is an effective solution for lung failure, however the lungs should be purchased legally, so that it supports the donor’s consent and no innocent lives are lost.  

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