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The Early Experience on Initiation of the
First Lung Transplantation Programme in the Country

Merih Kalamanoglu Balcı, MD and Cemal Asım Kutlu, MD
Sureyyapasa Chest Disease and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey

Güven Olgaç, MD
Camlıca Universal Hospital, Istanbul, Turkey

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Thoracic Surgery became an independent specialty after separating from Cardio-thoracic surgery in 1985 in Turkey, resulting in gross improvements in thoracic surgery overall during the last two decades. However, such a separation probably delayed the first successful lung transplantation in our country. That is to say, until recently, only the cardiovascular surgeons -by law- were eligible to conduct heart and lung transplantation programs and, as a result, they prematurely abandoned performing lung transplantations after a few unsuccessful attempts. In 2007, we established a lung transplant program and presented it to our National Organization for Organ Transplantation. It was approved and now, thoracic surgeons are entitled to perform lung transplants as well.

At the beginning of 2009, the first successful lung transplant was performed in our hospital—a tertiary chest diseases and thoracic surgery center—where more than 2,000 thoracic surgical procedures are performed annually, but without any experience in organ transplantation. Despite maximum efforts, the team faced a number of unforeseen problems (most of which were organizational) in the management of postoperative complications for subsequent patients. With the increasing workload of the team, we soon realized that a revision was required for the routine work of both surgical and anesthesiology departments as well as the need to attain contribution of other specialties to the transplantation program. During this reorganization process, we did not get enough support from the hospital management, making our improvements more difficult resulting, at times, in some undesired, and even chaotic, outcomes.

Although lung recipient selection criteria are well defined and widely accepted, it is common for a new transplant team to have a tendency to use their priorities for desperate cases. Likewise it was true in our country, especially for those presenting with silicosis for whom the team feels additional social pressure. Their whole course is unexpected in many occasions and timing for the operation is not well documented. Almost half of our initial cases were suffering from silicosis, and we had great difficulties at every stage of the process due to their unexpected course as a whole.

Members of our team trained at different transplant centers in the United States and Europe that employ differing protocols, such as performance of surveillence transbronchial lung biopsies postoperatively. Conflicts and dilemmas regarding many aspects of lung transplant are vast, especially for those situations that require urgent decision making. In this regard, it was troublesome for our team to develop a common approach to certain clinical problems.

Many issues originating from regional restrictions are inevitable and of course need some time to resolve; however, one issue that should not be resolved over time is the unanimous training of every member of the team by the same reference center willing to collaborate with the demanding team. It is this type of support that, from the very beginning, can positively influence a vulnerable transplant program.

Disclosure Statements:

  • Merih Kalamanoglu Balcı was granted by the Turkish Thoracic Society to have a 3 month Scholarship for training in the Department of Lung Transplantation at Loyola University, Chicago, IL, USA.
  • Cemal Asım Kutlu has no conflicts of interest to disclose.
  • Güven Olgaç has no conflict of interest to disclose.