June 24, 2010 -- For patients suffering terminal lung disease, the Lung Transplant Program at Brigham and Women's Hospital in Boston is a beacon of hope.
One of the many expert surgeons at Brigham, resident Dr. Daniel "Dibar" DiBardino is an up-and-coming star. After nearly a decade of training in the ultra-demanding cardiothoracic program, DiBardino, cocky and self-assured, is approaching the top of his game.
In April, DiBardino and his colleagues would be put to the test. A donor came up for two patients desperately awaiting lung transplants. A double transplant was suddenly in order. DiBardino was in charge of harvesting the lungs from the donor. He had had two hours' sleep.
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"Boston Med" cameras followed DiBardino and the senior attending physicians -- notably Dr. Michael D. Jacklitch and Dr. Phillip Camp, director of the transplant center -- in the lead-up to and aftermath of the surgery. We also spoke with lung recipients Maureen Bishop, 62, and Mary Ann White, 63, and their families.
"She is on oxygen 24-7 and the cord that she uses is a pain," said Ed White, Mary Ann's husband. "I was tripping over it and so was she."
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Maureen Bishop, 62, had smoked cigarettes and worked in heavy industry for decades. As a result, she developed emphysema. She could not breathe without an oxygen tank trailing her every step. She yearned for the simple things -- walking her dog, grocery shopping, attending church. She had been waiting for a lung transplant for three years.
Mary Ann White, 63, had no idea how she developed the progressive degenerative lung disease called idiopathic pulmonary fibrosis (IPF). A widowed mother of four with a gaggle of grandchildren and an adoring new husband, White also was on oxygen around the clock. She had waited 13 months for a transplant.
On April 5, 2009, White and Bishop received incredible news. They were each to receive a new lung from the same donor.
ABC News' Mary Flynn contributed to this report.
Lung Transplant: The Diseases
After 30 years of smoking, Bishop quit in 1999. Unfortunately, that wasn't soon enough.
Bishop was diagnosed with emphysema, one of two types of chronic obstructive pulmonary disease (COPD) -- the other being chronic bronchitis. Emphysema primarily affects the alveoli, or the tiny air sacs within the lungs, causing their deterioration. Chronic bronchitis is when the breathing passages of the lungs become inflamed and narrow, making breathing difficult and painful.
Although treatment exists to ease the coughing, wheezing and other symptoms associated with COPD, there is no cure.
Approximately 15 percent of smokers develop COPD. It is the fourth-highest cause of death in the United States, claiming 120,000 Americans each year.
Often smokers are unaware they have the early symptoms of COPD. The disease progresses slowly, and symptoms often develop gradually, so that by the time COPD is apparent, the disease is already well-established.
"Many Americans aren't aware that more women in this country die each year of COPD than from breast and lung cancer," says Dr. Mark Hellreich, pulmonologist from Mission Hospital in Asheville, N.C.
According to Hellreich, an early diagnosis can be a powerful motivator for smokers to quit; the disease progresses twice as fast if patients continue to smoke. Hellreich said diagnosing COPD requires a fairly simple procedure, a five-minute breathing test called a spirometry, that is available in many physicians' offices.
Idiopathic Pulmonary Fibrosis
The cause of White's disease was not so clear. When she developed IPF, doctors did not know how or why.
"The problem with my disease is that they have no clue what caused it," White said.
She said she just wanted the opportunity to once again enjoy her life, including spending time with her new husband, her children and her grandchildren.
IPF is a scarring or thickening of the lungs. It is less common, but far more deadly, than COPD. The average time from diagnosis to death for IPF patients is less than five years. Most patients die of respiratory failure within 10 years. But it's a relatively rare condition: An estimated seven to 43 of every 100,000 people in the United States develop IPF.
One common symptom of IPF is a noticeable change in a patient's breathing.
"If one month they are climbing stairs and then next month they are winded doing the same activity, it's cause for concern," said Dr. Phillip Camp, director of the lung transplant program at Brigham. "It's not just old age creeping up on you."
A definitive diagnosis of IPF requires a surgical lung biopsy. But doctors can occasionally diagnose the disease using a high-res chest CAT scan.
Currently, there are no FDA-approved medications available to treat IPF. Due to the aggressive nature of the disease, doctors recommend early referral to a lung transplant center shortly after diagnosing a patient.
For IPF patients, a transplant is the most reliable option.
COPD is the No. 1 disease warranting a lung transplant. IPF is ranked second. The death rate for people on the lung transplant waiting list is highest in IPF patients.
Lungs are a hard organ to come by. Only 15 percent of donated lungs are deemed appropriate for transplant, compared to 88 percent of viable kidneys and livers. One reason for this is because the lungs are more easily exposed to infection or irritants in the environment compared to other organs.
In New England, 65 percent of patients who received lung transplants suffer from pulmonary fibrosis, compared to the rest of the country, where most transplant patients suffer emphysema. Camp, the transplant center director, said researchers are unsure why New Englanders are more likely to have pulmonary fibrosis. Cold weather or industrial jobs are potential contributors.
Lung Transplants: The Surgeries
On the day Bishop and White's lung transplants were to be performed, Dibardino hopped on a plane to a location in New England.
A donor had agreed to give both lungs. DiBardino's job was to harvest the lungs as quickly (and carefully) as possible -- one for Bishop, one for White -- then get them back to Boston and split them. He transported the organs in a cooler packed with ice.
Time is of the essence in a transplant. The less time an organ spends in transit, the greater its probable viability.
"We really just need to get these things out and get home," DiBardino said at the donor hospital. "Now it's really about getting these things out the fastest and getting on the plane and getting the hell out of here, and get them sewn into the recipient as fast as we can. So we've got two good lungs for two patients."
DiBardino removed the lungs from the donor and got back on the plane.
"Everything we've done, we spent the last 12 hours preparing for this, we're on a clock, we have to get them back within the next four hours," he said. "It's not negotiable."
When DiBardino arrived back at Brigham and Women's Hospital, his colleagues flew into action. Two operating rooms had been prepared. Bishop and White were already anesthetized. Jacklitch and Camp were among the senior surgeons performing the transplants.
Both transplants were a success.
Long Wait for a Lung
Maureen Bishop's new lung arrived three years to the day after she was listed for a left lung transplant.
"This journey was a long journey," she said. "I'm going to fight to stand up and breathe again and do the simple things in life."
Camp said that although emphysema patients can live without a transplant, their quality of life is poor. The disease is a slow process of destruction, and the breakdown of the lungs over time can be emotionally frustrating.
"With emphysema, you can live a long life, but aren't living life," Camp said. "With a transplant, you are making the decision to reclaim your life. Because without it, you can't move much."
Each year, doctors perform 1,700 to 2,100 lung transplants in the United States. That number would be higher, if not for the primary limiting factor: a lack of donors.
After the Surgeries
The outcome of a surgery is judged on factors beyond survival. These factors include quality of life, physiological changes and cost.
The average survival of transplant recipients who receive a single lung is 4.4 years. Double lung recipients live an average of 5.7 years after surgery -- although the underlying disease and the patient's age can move the number either way.
Now 15 months since her transplant, Maureen Bishop is climbing stairs, making her bed and going grocery shopping all on her own.
"I can do everything but climb a mountain," she said.
Bishop said it has become easier for her to enjoy the company of her children, grandchildren and great-grandchildren. She attends rehab three times a week.
For her part, Mary Ann White said she is back to her old self again, after years of not being able to manage the simplest of tasks on her own. She was able to return to walking, taking trips to the shore with her husband and spending time with her grandchildren.
White even intends to get a part-time job in a local gift shop, she said.
Watch the full story of Maureen Bishop and Mary Ann White's lung transplants tonight on "Boston Med" at 10 p.m. ET