Lung transplants for COVID patients are rising. So are the ethical questions
The operations are expensive, risky, and use a scarce resource — donated lungs — that might otherwise go to patients with cystic fibrosis or other diseases.
Vezna Hang was a healthy 40-year-old who liked adventure, travel and zip-lining. He wasn't yet vaccinated against COVID in early March 2021. At the time, Florida hadn't yet opened vaccine access to people his age.
But Hang admits, he was hesitant to get the shot due to “all the politics that got involved."
Then, Hang tested positive for coronavirus. So did his girlfriend. She had many of the typical symptoms, while generally feeling fine. He just noticed losing his ability to taste and smell.
"And then one day, I just looked in the mirror and saw that my lips and my fingertips were blue," Hang recalled.
His girlfriend rushed him to the emergency room, where they discovered his oxygen levels were dangerously low.
"For the first moment in my life, I was scared. And from day to day, there were times that I honestly didn't think I was going to make it," Hang said. "And to leave behind my son, you know, that that was heavily on my mind."
He couldn't see his 5-year-old for months as he lay in a hospital relying on oxygen to survive. His lungs became so scarred, they didn't work anymore.
COVID can cause “chronic scarring of the lungs from the inflammation,” said Dr. Kiran Dhanireddy, executive director of the Tampa General Hospital Transplant Institute.
“Therefore, that scar doesn't allow for the blood to be oxygenated through the lung tissue in a normal fashion. And so the oxygen levels stay extremely low. And because that scar is permanent, there's no suitable alternative to transplantation to allow that individual to recover completely from COVID and lead a normal life.”
Hang received a double lung transplant in June. He is one of five COVID patients so far at Tampa General Hospital to receive one.
According to the United Network for Organ Sharing (UNOS), since the first lung transplant was done for a COVID patient in June 2020, there have been 233 more across the country.
"It's happening in the U.S. It's also happening in Canada. There was just a paper out from Western Canada about this is causing a huge surge in the number of lung transplants there. It's a big problem," said David Mulligan, the past president of UNOS, and currently the chair of transplantation at Yale.
Now that COVID vaccines are widely available, most people who require hospitalization for COVID are those who chose not to get vaccinated.
And since donated lungs are always a scarce resource, the fact that lung transplants are becoming more common for COVID patients raises ethical questions.
"When somebody contracts such severe COVID that they need a lung transplant, and they got it refusing to get a vaccine, it's a really ethical dilemma," said Mulligan.
"How can they just jump in and take a lung away from somebody who's sick, on the list, needs a transplant, but has been doing the best they can to take care of themselves and avoid getting COVID?"
About 7% of all lung transplants in the U.S. in the past year were given to COVID patients, according to UNOS.
The current system prioritizes people who are the sickest.
"If there were more lungs available for transplants, I believe the numbers would be greater than they are," said David Klassen, chief medical officer at UNOS.
The cost of a double lung transplant can be more than $1.2 million, according to the risk management firm, Milliman.
Reasoning that a wide range of vaccines have always been required in transplant cases, the American Society of Transplant Surgeons strongly recommends that all patients awaiting transplant get vaccinated against COVID-19 beforehand.
But it's up to individual transplant centers to make their own decisions. In some places, a patient could lose their spot on the transplant list if they are not vaccinated.
"There's no consensus amongst the transplant community about mandating vaccine,” said Dhanireddy.
“But there is a strong push to encourage patients before they get transplanted to be vaccinated because their response to the vaccine will be better, stronger than after their transplant," he said.
Hang got vaccinated as soon as he could, which happened to be after his operation. He now encourages other people to get vaccinated.
“This horrible virus hits everybody different,” Hang said. “You know, it's not predictable at all.”
He doesn’t know much about the man whose lungs saved his life, except that he was in his 50s.
Hang has been breathing with the donated lungs for about five months now. He recently celebrated his 41st birthday.
"It definitely changed the way I look at things," he said. "I wake up early. And I'm thankful I can still be here. I can pick up my son from school, and just to see his smile when he sees me, it means everything."
Even though he has some protection from the vaccine, Hang has to be cautious for life now. In order to keep his new lungs, he'll always be on anti-rejection medications that suppress his immune system, making him forever more vulnerable to COVID-19.