New lungs for the unvaccinated


Three unvaccinated or partially vaccinated patients whose lungs were destroyed by COVID-19 received a double lung transplant at the CHUM, learned The Press. These cases, the only ones in Quebec, show the extent of the possible ravages of the coronavirus. They caused a debate within the hospital. Should the unvaccinated walk past other sick people waiting for something as rare as organs?

Posted at 5:00 a.m.

“It’s still something quite drastic [de refuser une greffe]. The death penalty does not exist in Canada. They didn’t kill anyone. They just didn’t take the vaccine. They still have access to [soins] “, hammers the Dr Charles Poirier, medical director of the lung transplant program at the University of Montreal Hospital Center (CHUM), who follows the three patients.

The cases that interest us are unique to Quebec. They are complicated. And they are full of nuances.

First, the facts: These three patients were all perfectly healthy before they caught COVID-19. They contracted the virus six to eight months ago. Although eligible for vaccination, they were not adequately vaccinated. Not because they are anti-vaccine, specifies the Dr Pear tree. They also received a plethora of injections, including one against the coronavirus, before being transplanted. “Yes, they should have been vaccinated. Yes, they knew, but they weren’t people who were against vaccines. These are patients who said they didn’t have time: ‘I’m going to do it later, it won’t happen to me…’”, says the doctor.

Once infected, they developed “COVID-19 pneumonia” which led to fibrosis, scarring of the lungs causing shortness of breath and a constant need for oxygen, irreversible in their cases.

This is a rare but very real complication of the coronavirus. If they did not receive new organs, they would never have been able to leave the hospital. They needed too much oxygen. They were in danger of dying.

As is the case with every transplant, the patients were evaluated by a multidisciplinary team, made up of doctors and healthcare professionals, according to the same criteria as all other patients. We wanted to make sure they were physically and mentally fit to go through the procedure. “Very ill”, the three were placed on the “urgent” organ donation waiting list – there are two, depending on the state of health: the “regular”, where the wait is a few months , and the emergency, where the sick go first. In these specific cases, they were operated on within one to six weeks, depending on the person.

A ravaged health

Suzanne* is one of these three patients. For her, it all started last summer with classic symptoms: fever, vomiting, diarrhea. She was returning from a trip.

She passed a screening test. Negative.

At the time, even though she was eligible for the vaccine, Suzanne was not vaccinated. She is neither conspiratorial nor antivaccine. Simply, in her family, we keep the drugs as a very last resort, she says. “We were in good health. We said to ourselves: why take it? explains her husband, Stéphane*. He answered most of our questions. His wife is still too out of breath. She struggles to say a sentence without coughing.

Soon, his condition deteriorated. To the point where the family called the ambulance. The 49-year-old mother of five initially spent two months at the Jewish General Hospital, including five weeks intubated and in a coma. Diagnosis: COVID-19. In the end, she had to be hooked up to an “artificial lung”, a machine commonly known as ECMO, by which blood is supplied with oxygen outside the body.

To his family, the doctors said there was nothing more to be done. “We insisted,” says Stéphane. The option of the transplant was finally considered. A series of tests showed that all of Suzanne’s other organs were in perfect condition, a condition sine qua non. “She was still young. She was in perfect health. We didn’t want to sacrifice a 49-year-old, ”said her spouse. She was transferred to the CHUM and placed on the waiting list. In less than a week, a compatible donor was found. “She was very lucky. »

After long months of recovery in the hospital, of which the wife has very few memories, she is back home. She does not think of her ravaged health. She focuses on her children.

Still, she bitterly regrets not having been vaccinated. “She lost a lot of weight. Everything is upside down. I don’t wish this on anyone. It’s really difficult, ”said her husband, who went to her bedside every day.

The Dr Poirier holds a similar discourse. “We did not think that COVID could cause such major complications and that people would need a lung transplant. It is a sequel that is irreversible. This patient who has not had a vaccine ends up with a [espérance de vie] average of about five years [après la greffe]. It is nevertheless a not trivial consequence. You are in great shape. You have COVID-19. You go to the hospital and you go out with a lung transplant, ”he illustrates.

Questions

Beyond their unprecedented nature, these transplants have created a stir within the walls of the university hospital, caregivers not being particularly comfortable with the idea that unvaccinated patients take the place of other patients. at the top of waiting lists for new lungs. And the Dr Poirier expects to see more.

A health care source who is not authorized to speak publicly about this case confirmed to The Press, on condition of anonymity, that the situation has made certain doctors and nurses at the CHUM react “very strongly”, who are reluctant to take a position publicly.

Health professionals are thus wondering whether they should not have given priority to vaccinated people who have followed the recommendations of doctors and are anxiously awaiting an organ.

“Obviously, that raises questions. But you don’t put someone on an organ donation list for no reason. Each case is assessed. We have to feel that there is a change. In the same way that a heavy smoker who has lung cancer would not have a transplant if he still smokes like a chimney, ”explains a CHUM doctor who requested anonymity.

“There were a lot of questions, that’s for sure, agrees the Dr Pear tree. We went back to square one to say: it’s not because they smoked, or because they worked in asbestos or they were in the mines and they had a pulmonary consequence we’re going [leur refuser] the transplant. The idea is: there is a current disease. Are these candidates for transplantation? If so, we go to the transplant. »

The selection criteria, he repeats, are not specific to people with COVID-19. They are the same for everyone. “It was not a decision of one person, it is a team including intensive care people who decides”, explains the doctor, who adds that the caregivers were based in particular on what was happening abroad. , where many transplants on COVID-19 patients have taken place over the past two years.

“People who were more skeptical at the start were less so,” says the pulmonologist. Those who remain a little perplexed are the same people who wonder why we should treat [les non-vaccinés], why they should come to the emergency room, why they should be intubated. It is a societal choice. You could say that we don’t treat people who don’t pay attention to their diet and who have a cholesterol problem or heart disease. [Dans] Canadian society, everyone has access to health care, regardless of the reason, even if there are things that we would have [pu faire] to avoid that. The empathy stays there. We are not here to judge. »

* Fictitious first names

With the collaboration of Ariane Lacoursière, The Press



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