Since the onset of the Covid pandemic, Dr Sanath Kumar, a 30-year-old anaesthetist and intensivist at a private hospital in Bengaluru, was working tirelessly. With his expertise, he was in the ICU, treating critically ill patients. But the deadly virus did not spare him. During the second wave, he contracted the disease, which ravaged both his lungs.
It started with a fever and cough that was later diagnosed as Covid-19. His condition didn’t improve with medication. One day, he felt a sudden pain in his chest and developed resistant hypoxia (a condition where tissues are unable to absorb oxygen). Due to this, his oxygen level dropped drastically to 60% and he was put on a mechanical ventilator for respiratory support. He was later shifted to a different facility where he was put on extracorporeal membrane oxygenation (ECMO) support and doctors there waited around 3-4 weeks to see if his lungs improved. Nothing changed and his only option was to get a double lung transplant. Luckily for him, a pair of lungs from a cadaver donor matched and the damaged organs were replaced in a rather risky situation. This is the first double lung transplant done on a patient whose lungs were damaged due to Covid-19 in Karnataka.
Dr Sandeep Attawar, director of thoracic organ transplants at KIMS Heart and Lung Transplant Institute, was the lead surgeon in this rare surgery. Explaining the complexities involved in this case, he said, “A double lung transplant is a very demanding surgery but was the only option for Dr Sanath’s survival. The infection had an exaggerated immune response to it, and the body’s failure to properly repair the injury. Eventually, in the self-repair phase, the deposition of yellow fibrotic scar tissue creates liver-like densification that makes the lungs completely solid. This process of misdirected and inappropriate self-repair irreversibly destroys the tiny alveolar air sacs through which gas exchange happens. Patients only survive to the fibrotic stage if they are intubated and at times transitioned to ECMO support. This harmful scarring can occur within a couple of weeks of viral pneumonia. What makes this surgery uniquely complex is the subset of patients that are forced to accept this option. They are intubated, deconditioned, nutritionally inadequate and suffer from airway and bloodstream infections during their prolonged hospitalisation. Treating these critically ill patients successfully with a double lung transplant underlines the overall abilities of a high-quality transplant programme.”
Dr V Arun, lead consultant – anaesthesia and critical care, Aster CMI Hospital, was also a prime member of the surgical team. He said Dr Sanath’s case was both emotionally and clinically challenging since they belong to the same fraternity. “It was difficult to see a colleague whose lung damage had progressed so far. When he was referred to us, he was intubated and was on 100% oxygen support but barely having enough oxygen in his bloodstream to survive. Luckily he remained stable over the next few weeks while we waited for a suitable donor match for him. We were able to find a suitable match after four weeks and he underwent a lung transplant,” he said.
Being a specialist himself, Dr Sanath Kumar knows the severity of his condition and agrees it is nothing less than a miracle that he is alive today. “When I tested positive and started taking medicines, I thought I would recover soon. I had never imagined that I would suffer severely and end up having a lung transplant.”
Following the surgery, Dr Sanath Kumar is at home with his family and has been advised to stay indoors in a secure environment to minimise the risk of reinfection.
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