A lung transplant operation performed here three weeks ago is one of a growing number of organ transplants being attempted across the country.
An operation so rare that perhaps 50 have been performed around the world, lung transplantation was first attempted on a human in 1963. That person lived for 18 days.
Since then, only one patient has lived as long as 10 months, and a spokesman for the National Heart, Lung, and Blood Institute, commenting on length of survival for lung transplant patients, calls it "essentially zilch."
In New York, where Montefiore Hospital and Medical Center is generally regarded as the country's leader in lung transplants, the director of the transplant program speaks of his track record in terms of weeks.
"They all lived for over two weeks -- except one," says Dr. Frank J. Veith, who has performed seven lung transplants. "There have also been two partial successes, a Belgian man, who lived for 10 months, and one of our own patients. He lived six months -- he was an older man, in his 60s, with a number of problems. Actually, he was doing very well when he died."
The most recent patient, who underwent surgery Sept. 24, is a 25-year-old gardener, Scott Wilson, of Boca Raton, Fla., whose lungs were destroyed when he accidently inhaled the highly toxic herbicide, paraquat.
Wilson may, however, have a brighter future than other lung-transplant patients.
He has been treated with a relatively new drug, Cyclosporine A, which, according to specialists, has extended the survival rate of a variety of transplant patients by reducing the possibility of rejection. He was also, according to his surgeon, lucky enough to receive the lung of a young man that was a good match to his own damaged lungs. And if he faces a tough battle now, fighting for his life in a special intensive-care unit in the Bronx, his chances are better than they might have been without a transplant.
Purple from lack of oxygen, so ill that doctors were afraid to turn him on the operating table, Wilson had no chance of survival before his transplant, according to his physician. Now, 19 days after his six-hour, all night operation, there is at least a chance.
Wilson's story began Aug. 30 at his home in Pompano Beach. A sandy-haired, outgoing man with a wife and four children, Wilson had been doing a routine job -- spraying weeds with paraquat.
A toxic and controversial pesticide that has been used to kill marijuana plants, paraquat has been a source of controversy among politicians, physicians and environmentalists. In 1978, Joseph A. Califano Jr., then secretary of Health, Education and Welfare, found that marijuana contaminated with paraquat could lead to lung damage for regular and heavy users of marijuana. This year, however, the Drug Enforcement Administration disputed those findings and, with the blessings of the Environmental Protection Agency, approved the use of paraquat for eradicating domestic marijuana crops. It has been used in Florida and Georgia.
The details of the accident that injured Wilson are unclear. Apparently, according to newspaper accounts and other secondary sources, there was an explosion of the spraying system and Wilson swallowed and inhaled paraquat--how much is not known. He spat out the paraquat he had in his mouth, according to what he told his wife later, and resumed his work.
No physical problems were apparent until five days after the accident, when Wilson sought medical attention, complaining of shortness of breath. The shortness of breath continued, and kidney failure developed.
Doctors at Shands Teaching Hospital in Boca Raton attempted to filter the paraquat from his system. As Wilson got sicker, he was transferred, Sept. 13, to Montefiore.
There the process of filtration continued, because it was feared that the paraquat in Wilson's body might infect the donor lung. His kidneys began to improve, but his lungs continued to deteriorate.
"He couldn't be ventilated. we were using all our tricks, but he just wasn't getting enough oxygen," Veith says.
A lung transplant was essential, but the wait for lungs at Montefiore has averaged six months, according to Veith. Thirty patients had been referred there, and in most of the cases Veith had been unable to proceed because no suitable organs were available.
It was not merely a lack of donors, he explained. More than in the case of a heart, or a liver, the size of the lung had to be very close.
With Wilson failing fast, Montefiore went to the newspapers with a public appeal Sept. 21 and got lucky within four days--the family of an 18-year-old auto accident victim who had been declared brain dead decided to donate his organs "to give somebody else life."
The donor lungs were not perfect: there was pneumonia in the right, a bacterial bronchitis infection in the left, but doctors had little choice. They chose the healthier lung, the left.
Yesterday, Wilson, according to one of his doctors, was "in critical condition, experiencing difficulty breathing with his own remaining lung," but still alive. His kidneys, after blood filtration, are now almost back to normal. There is still some paraquat in his system, but the amount does not appear "severe."
His problems are the problems all transplant patients face: infection, rejection of the new organ, and the healing process. There is also the possibility of the remaining paraquat's damaging the new lung.
The next six weeks, according to his doctors, will be critical. Wilson knows this. His wife, Lucille, knows this. They are participants in an experimental operation with the odds against them, but when Lucille feels strong enough to talk to reporters, she tries to be optimistic.
"In spite of what the doctors tell me, I still think he's going to make it," she says.