Lung transplants pioneered in T.O.
By Elaine Carey
The Toronto Star, September 11, 2003, Thursday Ontario Edition
Survival rate increases to 70 per cent
Dr. Joel Cooper rhymes off the names and dates as if they were his children's
birthdays - Tom Hall, Nov. 7, 1983; Ann Harrison, Nov. 26, 1986; Lawrence
Weisgerber, March 26, 1988.
They are the days when the world-renowned surgeon performed the first
successful lung transplant in the world, followed by the first successful
double-lung transplant, then the first two-lung transplant on a patient with
cystic fibrosis.
All of those world firsts were performed at the Toronto General Hospital.
This year marks the 20th anniversary of that first triumphant operation on
Hall, a 58-year-old hardware executive who was dying of pulmonary fibrosis, a
progressive lung disease.
Only 44 lung transplants had been attempted worldwide before - and none of
the patients had survived more than a few weeks.
Since then, more than 1,300 lung transplants have been performed in Canada,
according to new figures released yesterday by the Canadian Institute for Health
Information.
In the past decade, the number of lung transplants has more than doubled,
from 59 in 1993 to 141 in 2002, performed at five transplant centres in Canada
and the three-year survival rate has increased from 40 to 70 per cent.
It is the only organ transplant that is performed here as frequently as in
the United States.
"I never thought I would see the day when 95 per cent of lung transplant
patients get out of hospital alive. The first one was zero for 45," Cooper said
in a telephone interview from St. Louis, Mo., where he now heads the lung
transplant program at the Washington University School of Medicine.
Without Cooper's dedication, it would never have happened, said Dr. Shafique
Keshavjee, who now heads the Toronto lung transplant program.
"He had a vision that this could be done. His persistence and the research he
did is what made it happen," said Keshavjee, who began working as a medical
resident with Cooper in 1986.
"At that time, you would tell patients they had about a 50 per cent chance of
survival," he said. "Now, 20 years later it's 90 per cent and we're doing 60 a
year instead of one or two.
"That's a degree of success that is really unprecedented," he said. "Lung
transplant is a Canadian success story. We have led the world."
Hall lived for six years, three months and 10 days after that first operation
before dying of kidney failure, a side effect of the strong anti-rejection drugs
that transplant patients must take.
While many lung transplant patients receive kidney transplants to overcome
it, Hall didn't want that, Cooper said.
"He was a great fellow but he felt he didn't want to proceed any further."
Cooper came to Canada from the U.S. in 1972 and credits the Canadian health
care system with allowing him to develop the lung transplant program.
But he returned to the U.S. in 1988, frustrated with budget cuts that meant
chronic shortages of equipment, long waits for diagnostic procedures and cuts to
research budgets that made his work increasingly difficult.
"For the first 10 years, I thought Canada had a good health care system and
then the resources began to run dry," he said. "It became apparent we couldn't
deliver the kind of care we wanted."
Getting research dollars in an era of shrinking health budgets has become so
competitive that "you spend more of your time trying to get dollars than you do
doing research," Keshavjee said. "It shouldn't be that way."
Despite those cuts, the University Health Network, which includes Toronto
General, has pledged to continue its innovative program and state-of-the-art
transplant operating rooms have just opened, replacing ones that were built in
1956.
"This is what Canadians deserve," he said. "We put a lot of money into health
care and we should be able to see it."
Peter Cantisano, received his new lungs in one of those operating rooms on
July 1 this year. A lifelong smoker until six years ago, he had severe emphysema
that meant "I couldn't walk from one end of the room to the other without
oxygen," he said. "I just couldn't breathe anymore."
Now, "I'm nine weeks old and I'm starting my life again, thanks to other
people who donated my lungs," said the 64-year-old grandfather of nine.
In fact, he went to a driving range to hit some golf balls this week for the
first time in 41/2 years.
"It was so good," he said. "It just feels amazing to be able to breathe
again."
