From Turin comes a story of transplants with a recipient who becomes a donor. A 43-year-old patient with severe pulmonary disease underwent a combined transplant of heart and two lungs, and his heart was explanted and donated to a patient with severe terminal heart disease. “After almost thirty years of not being performed in Italy, the domino heart transplant has once again proved to be a ‘simple’ strategy to solve a complex problem”, they say from the Molinette hospital in Turin where the operation was performed. Thanks to the first donor, the paths of three people cross for a moment with the passage of a particular baton: the donor gives the heart-lung block to a patient who receives it and in turn gives his “discarded” heart to a second patient. The Director General of the Citta della Salute of Turin – Giovanni La Valle – declares himself proud of this intervention which sums up well the high complexity and excellence of the treatments available in the Molinette hospital. He also underlines how heart transplantation can only be performed from a deceased donor, except in this very rare situation, where the donor is alive, a truly unique case, which allowed life expectancy in another recipient awaiting a transplant.
For the 43-year-old patient, the only option is to replace the entire cardiopulmonary block
A 43-year-old man suffers from severe lung dysfunction due to Young’s Syndrome. The patient is Sicilian, but decides to entrust himself to the care of the Heart and Lung Transplant Center directed by Professor Mauro Rinaldi. From the analyzes it is discovered that the transplantation of the lungs alone is not feasible due to a serious discrepancy in the size of the left chest compared to the right one. For the Turin doctors, the only possibility is to replace the entire cardio-pulmonary block, but his heart is young, not sick, and cannot be wasted. The doctors then decide that he can be recovered and transplanted into a second patient. Meanwhile, the patient is ill, is hospitalized several times and for a long time because he needs oxygen and has recurring infections. The wait for organs is long and starts before the Covid epidemic. Time passes and his lungs are increasingly damaged. At the end of December 2022 he was transferred back to the Molinette. Shortly before New Year’s he is very ill and is hospitalized in the Intensive Care Unit of Cardiac Surgery (coordinated by Dr. Anna Trompeo, from the team of Professor Luca Brazzi), where he is intubated and attached to a mechanical ventilator. The severity of the disease allows doctors to launch a nationwide appeal for an urgent heart and lung transplant. Finding three suitable organs is not easy, despite being registered on the national list of emergencies. Fortunately, his lung function, although severe, stabilizes. Hope comes at the end of April: the Regional Transplant Center (directed by Professor Antonio Amoroso) reports, on the recommendation of the National Transplant Center, the availability of a heart-lung block from a donor in Rome. The race against time and the organization of the complex domino transplant begin.
Two patients, at the same time, in two neighboring operating theatres
A cardiac surgery team leaves for the sampling, the patient is transferred to the operating room and a 51-year-old woman suffering from biventricular arrhythmogenic dysplasia is called to the hospital to receive the heart which otherwise would have been wasted. It’s a complex organization. Everything is ready: the two recipients (one for the heart-lung block) and the other (for the heart explanted in the operating room next door) are ready to receive the precious gift as it arrives in Turin. The intervention of the heart-lung block is particularly complex: the lungs are seriously damaged, the chest is asymmetrical and then it is not necessary to damage the heart that the patient is waiting in the operating room next to. The operation, performed by Professor Mauro Rinaldi with the help of Professor Massimo Boffini, which lasted over ten hours, went perfectly: the new heart and lungs were implanted and in the other operating room the explanted heart was implanted in the second patient.
The realization of these two linked transplants is the culmination of an important effort, both by the national transplant network and by the Molinette hospital, which translates the generosity of the citizens who have consented to the donation into treatment. Currently the two patients are improving and their course appears regular, giving hope that they can fully enjoy this beautiful “gift”.