Dennis Lee Boss is breathing easy for the first time in years.
He’s the first Spectrum Health patient to get a new set of lungs as part of an important clinical trial.
His life post-surgery? “A miracle in the making,” he said.
For Boss, of Shelbyville, Michigan, the health journey began more than four years ago when he suffered a collapsed lung. He still remembers the intense pain.
“I started coughing and hacking and gasping for air and I couldn’t stop,” he said. “Usually, I could catch my wind, but I couldn’t this time.”
His wife and his daughter called for an ambulance.
He spent the next 45 days in the hospital.
But like many patients with chronic lung problems, recovery took a winding path.
A day after he went home, his lung collapsed again. He went back to the hospital, this time for a few weeks.
On the list
At about that same time, his COPD worsened. He had to go on oxygen. The simplest activities, like walking to the mailbox, became too much.
By June 2020, doctors at the Spectrum Health Richard DeVos Heart and Lung Transplant Program told him a transplant would be his best hope for survival. Influenced by friends and family, he made the decision to pursue the procedure.
He began the complex process of qualifying for a transplant, including multiple tests to determine if he was healthy enough to withstand the surgery.
By Oct. 1, he made the list.
He joined an estimated 107,000 people in the U.S. who are waiting for their phones to ring with news about a transplant.
Boss, 61, knew the odds, too.
A new name is added to the list every nine minutes. About 17 people die each day waiting for a transplant, according to federal statistics.
But one afternoon in early November, just as he’d checked into a routine appointment for lung therapy, his cell phone rang.
“They had a pair of lungs for me,” he said. “I called my wife, who was out shopping with my daughter. I went home. She met me there and we grabbed my bag, which was already packed. We made it to the hospital by 4 p.m.”
Lung transplants are extraordinarily complex procedures. They’re also relatively rare, reserved as a last resort for patients with chronic lung disease and a poor survival outlook.
An estimated 2,000 lung transplants are performed in the U.S. each year, compared to about 18,000 kidney transplants. The team at Spectrum Health performs about 50 lung transplants each year.
Typically, they are used for those who are bedbound or, like Boss, extremely limited in activity tolerance.
But Boss’ experience took on a special significance.
The research, run by Lung Bioengineering and currently testing in 14 sites in the U.S., examines a new way to test donor lung function before the transplant occurs—in a way that minimizes organ waste.
“Donor lungs come from deceased patients and we’re grateful for their generosity in making transplantation possible,” said Gayathri Sathiyamoorthy, MD, who specializes in pulmonary, critical care and internal medicine at Spectrum Health.
But all too often, the lungs go unused.
By some estimates, as many as 50% are ruled unsuitable for transplants.
“Sometimes the X-ray looks bad, or the oxygen levels are low,” Dr. Sathiyamoorthy said, “and these findings are concerning for poor lung function, when in fact they may not be fully expanded or have a little extra fluid in them.”
This new trial evaluates lungs that go on the ex-vivo lung perfusion machine against lungs that do not for similar patients.
Lungs included in the trial are taken from the donor’s body and flown immediately to Lung Bioengineering’s Silver Spring, Maryland, facility, where they are attached to an artificial breathing and circulatory system.
From there, doctors can fully expand the organs and examine them.
“They can determine whether the lung is truly damaged and should be discarded, or whether it can be used in a patient (participating in the trial),” she said.
Spectrum Health’s transplant team has been using a similar testing process for several years. But this trial is evaluating a newer device and process, Dr. Sathiyamoorthy said. As of mid April, the Spectrum Health team had made four referrals to Lung Bioengineering, which resulted in three additional transplants.
“Our hope is that this technology allows us to increase our ability to offer (suitable) lungs to our patients,” she said.
Against the clock
While Dr. Sathiyamoorthy’s explanation sounds straightforward, the process runs on an intensely tight timeline.
Within hours, she said, the lungs are flown to Maryland and attached to the experimental device.
They are then perfused, or “artificially kept alive,” Dr. Sathiyamoorthy said. “And we can gain some time to assess the lungs, to ensure their function is to our standard.”
The lungs are evaluated for several hours.
If they don’t seem perfect? They’re ruled out for transplantation and may be used for other research instead.
“And if the pair of lungs look great, it’s taken off that support and flown right to us so that we can give it to our patient within a few hours,” the doctor said.
In his case, Boss and his family had to wait to see if the new lungs would get the green light.
“The transplant team warned me that I might have to wait months, or even years, before lungs became available,” he said. “I knew how lucky I was to get the call in less than 40 days.”
Ultimately, he matched.
Boss recalls little about the transplant procedure.
Edward Murphy, MD, section chief of cardiovascular surgery at Spectrum Health, performed the transplant.
“This trial increases our confidence in the lungs that we transplant into our patients,” Dr. Murphy said. “By participating in the clinical trial, we have the opportunity to collaborate with lung transplant experts.”
He’s pleased Spectrum Health is able to offer this level of treatment to patients such as Boss while also increasing the knowledge base of the entire scientific community.
After his transplant, Boss spent three days in the intensive care unit. He has only a hazy recollection of that period.
By the time he moved to his own room, he could breathe on his own—and he recognized just how amazing that was.
He returned home from the hospital after three weeks. He’s felt better with each passing day.
“I’m tinkering in the garage again,” he said. “I can even walk down the road without stopping for breath.”
He wishes every person with crippling lung disease could have this chance to receive a lung transplant.
“If I could, I’d tell them all this process is so worth it. Yes, it takes time to recover. You have to have patience. Just like my COPD didn’t happen overnight, my recovery won’t either.”
By participating in this trial, the Spectrum Health transplant team hopes more people will join Boss on the road to transplant.
“Most of us just don’t think about breathing,” Dr. Sathiyamoorthy said. “It’s just something that happens in the background.
“But for patients who struggle to breathe daily, it’s miraculous what a lung transplant can do for them. They’re usually off oxygen when they go home and, for the first time in years, can breathe normally.”
That kind of miraculous transformation never gets old, she said.
“I first saw a lung transplant while training at the Cleveland Clinic,” Dr. Sathiyamoorthy said. “And I quickly realized what incredible work it is.”
As a pulmonologist, she’s accustomed to seeing patients who are breathless and struggling.
“We try and help with drugs and inhalers,” she said. “But after a transplant, patients come back as a new person—and that’s just amazing.”
Boss is full of gratitude. While it’s still too soon, he thinks he’ll eventually write to thank his donor’s family.
“Whoever they are, I know they have to grieve,” he said. “But I want to thank them. This wouldn’t have been possible without them.”