First lung transplant

Background

On 19 November 2000, Singapore’s first lung transplant operation on 54-year-old Thanvanthri N. Veerappan was performed.¹ The team of lung transplant surgeons included two directors of Singapore’s heart-lung programme, Drs S. Sivathasan and Tong Ming Chuan, as well as lung expert Dr T. Agasthian. In an operation that lasted about nine hours, the team successfully transplanted a pair of healthy lungs from the late Yap Chee Kian to Thanvanthri.²

Background
Lung transplantation is a necessary treatment for lung diseases that cannot be cured with medication.³ A lung transplant is as complex as a liver transplant, and technically more difficult than a heart transplant. It is also difficult to get lungs as transplant organs because they must not be damaged or infected. As such, ruptured lungs from accident victims are often unsuitable for transplants.⁴ While technology and expertise for lung transplantation were already available at the National Heart Centre by mid-2000, no suitable donor had been found.⁵

Doctors use three criteria to determine a lung transplant recipient: lung size, chest measurement and blood type. The difference in lung size between the donor and recipient cannot be more than 10 percent, and their blood groups must be compatible. Once donor lungs are available, they are assigned to the person on the waiting list who is most in need and matches the donor size and blood group, not the patient who has waited the longest.⁶

According to international data, half of lung-transplant recipients live for at least five years. The probability of survival is higher if there is a better match in terms of blood type and lung size between donor and recipient.⁷

History
The decision to carry out Singapore’s first lung transplant was made on 19 November 2000.⁸ This was because a pair of suitable donor lungs had been found for the patient who needed it most at the time – Thanvanthri, a 54-year-old male shipping consultant.⁹

Thanvanthri, a non-smoker, was first diagnosed with pulmonary fibrosis, or scarring of the lungs, in mid-1995.¹⁰ The cause of his condition was unknown. From 1998, Thanvanthri’s condition deteriorated, causing difficulty in breathing and tiring him out easily. He was finally hospitalised and hooked up to a respirator that provided him with 10 litres of oxygen daily. By 15 November 2000, Thanvanthri’s condition had become so critical that doctors gave him only weeks to live.¹¹

A few days later, Yap suffered a ruptured artery in her brain while visiting her mother at Tan Tock Seng Hospital.¹² The 39-year-old Chinese female was rushed to the Accident and Emergency Department and diagnosed with a brain haemorrhage. She was admitted to the National Neuroscience Institute located next to Tan Tock Seng Hospital. She died on Saturday morning, 18 November 2000 (about 24 hours after her admission to the National Neuroscience Institute).¹³

After being approached by a transplant coordinator from the Singapore General Hospital, Yap’s husband, Choo Hong Seng, a hotel engineer, gave his consent to donate Yap’s organs. He did so after consulting with his late wife’s father, who gave his approval. Choo felt that it was the right thing to do as others would benefit from Yap’s donated organs. Doctors thereafter removed Yap’s lungs, kidneys, eyes and skin for various transplants.¹⁴ She had O-type blood and was thus a universal donor.¹⁵

Description
A team of lung transplant surgeons worked from about 8 pm on 19 November 2000 to about 5 am the following morning to remove and transplant Yap’s lungs to Thanvanthri. Time was of the essence as donor lungs should ideally be transplanted within six hours of its removal. The lungs were packed in ice and rushed from the National Neuroscience Institute to Singapore General Hospital, where Thanvanthri had already been prepared.¹⁶

Post-operation
Initially, the doctors were not very optimistic about Thavanthri’s recovery as his body had shown signs of tissue rejection on the day he received the new lungs.¹⁷ He suffered a bout of pneumonia a week after the operation, which landed him back into the intensive-care ward for four days. However, Thavanthri pulled through and was well enough to go home a month later. He was feeling much better and could talk without gasping for breath.¹⁸

Doctors monitored Thavanthri’s condition closely for the first six months after the operation, which is the riskiest phase for rejection and infection.¹⁹ Within those six months, Thavanthri’s body rejected the new lungs more than once and he suffered several rounds of infection. He struggled daily against fever, throbbing headaches, diarrhoea and nausea. In June 2001, an infection blurred his left eye which left it permanently damaged. The transplant also weakened his immune system, leaving him vulnerable to even the common cold.²⁰ Doctors feared that he might not survive.²¹

It was only in 2002 that Thavanthri’s condition stabilised and improved. In 2003, he restarted his shipping agency.²²



Author
Nureza Ahmad



References
1. Salma Khalik, “Gift of Life This Festive Season in First Lung Transplant Here,” Straits Times, 22 Decemeber 2000, H2; Salma Khalik, “Lung Transplant First for Singapore,” Straits Times, 22 November 2000, 1. (From NewspaperSG)
2. Khalik, “Lung Transplant First for Singapore.”
3. “Donor Needed for First Lung Transplant,” Straits Times, 19 May 2000, 4. (From NewspaperSG)
4. Khalik, “Lung Transplant First for Singapore.”
5. “World-Firsts and Success for Researchers in S’pore,” Straits Times, 28 December 2000, 15; Khalik, “Lung Transplant First for Singapore.”
6. Khalik, “Lung Transplant First for Singapore.”
7. Khalik, “Gift of Life This Festive Season.”
8. Khalik, “Lung Transplant First for Singapore.”
9. Khalik, “Lung Transplant First for Singapore”; Khalik, “Gift of Life This Festive Season.”
10. Salma Khalik, “First Lung Recipient Marks Year at Deepavali,” Straits Times, 15 November 2001, 3. (From NewspaperSG)
11. Sharmilpal Kaur, “With New Lungs, He’s Grateful for Each New Day,” Straits Times, 6 October 2003, 8. (From NewspaperSG)
12. Salma Khalik, “She Is Dead, but Lives On in Others,” Straits Times, 22 December 2000, H2. (From NewspaperSG)
13. Khalik, “Lung Transplant First for Singapore.”
14. Khalik, “She Is Dead.” 
15. Khalik, “Lung Transplant First for Singapore.”
16. Khalik, “Lung Transplant First for Singapore.”
17. Khalik, “First Lung Recipient Marks Year at Deepavali.”
18. Khalik, “Gift of Life This Festive Season.”
19. Khalik, “Gift of Life This Festive Season.”
20. Kaur, “He’s Grateful for Each New Day.”
21. Khalik, “First Lung Recipient Marks Year at Deepavali.”
22. Kaur, “He’s Grateful for Each New Day.”



The information in this article is valid as of October 2020 and correct as far as we are able to ascertain from our sources. It is not intended to be an exhaustive or complete history of the subject. Please contact the Library for further reading materials on the topic.