Meet the Two COVID-19 Patients Who Received Double-Lung Transplants at Northwestern Medicine
Northwestern Memorial Hospital July 30, 2020
“Mayra and Brian wouldn’t be alive today without the double-lung transplants. COVID-19 completely destroyed their lungs and they were critically ill going into the transplant procedure making it a daunting undertaking,” says Ankit Bharat, MD, chief of thoracic surgery and surgical director of the Northwestern Medicine Lung Transplant Program who performed the transplants. “However, our transplant team was committed to doing everything possible to save their lives and spent weeks preparing. The transplant procedure required a tightly coordinated effort from a multidisciplinary surgical team. When we opened Mayra and Brian’s chest cavities, large parts of their lungs were necrotic and filled with infection. The severe damage and inflammation to the lungs had caused pressure overload on the heart which further made the surgery quite complex. One misstep in the operating room could have led to catastrophic consequences. Nevertheless, the success of these transplants emphasizes that surgical innovation can also play an important role in helping some critically ill COVID-19 patients.”
Since performing the first known double-lung transplants on COVID-19 survivors in the United States, the Northwestern Medicine Lung Transplant Program has been offering guidance to other transplant centers around the world.
“We want other transplant centers to know that – yes – this is challenging, but it can be done safely,” says Rade Tomic, MD, a pulmonologist and medical director of the Northwestern Medicine Lung Transplant Program. “While lung transplantation isn’t for every patient with COVID-19, it does offer some of the terminally ill another option for survival – Mayra and Brian are living proof. Both patients continue to get stronger every day and we’re thrilled with their progress.”
Mayra Ramirez: First COVID-19 Patient to Receive a Double-Lung Transplant at Northwestern Medicine
Mayra Ramirez, who is originally from North Carolina, moved to Chicago in 2014 and started working as a paralegal. The 28-year-old enjoys running, traveling, spending time with family, friends and her dogs. Other than a diagnosis of neuromyelitis optica (NMO), an autoimmune disease that affects the spinal cord and nerves of the eyes, Ramirez was healthy and took extra precautions when COVID-19 hit Illinois.
“In March, I started working from home and never left my house,” explains Ramirez. “But in April, I contacted my doctor, complaining of fatigue, chronic spasms, diarrhea, and loss of taste and smell. I only had a slight temperature of 100 degrees, so I monitored my symptoms from home and kept in touch with the COVID-19 hotline every day. It wasn’t until April 26 that I felt really bad and went to the emergency department. From there, everything was a blur.”
Within ten minutes of being admitted to Northwestern Memorial, Ramirez had to be placed on the ventilator. She spent six weeks in the COVID ICU on a ventilator and ECMO. By early June, her lungs showed irreversible damage and it was clear that only a double-lung transplant could save her. The transplant team completed an urgent evaluation and within 48 hours of being listed for a double-lung transplant, Ramirez received the life-saving procedure on June 5, becoming the first known patient in the United States to receive a double-lung transplant after surviving COVID-19.
“This virus overwhelmed Mayra’s lungs. For many days, she was the sickest person in our COVID ICU and possibly the entire hospital,” explains Beth Malsin, MD, a pulmonary and critical care specialist. “Mayra had care providers numbering in the hundreds. Nurses specifically trained to care for critically ill patients worked with her one-on-one providing bedside care for their entire shift. Once Mayra’s body cleared the virus, it became obvious that the lung damage wasn’t going to heal, and we needed to list her for a lung transplant.”
“I don’t remember anything during my six weeks in the COVID ICU. When I finally woke up, it was the middle of June and I had no idea why I was in a hospital bed. Wiggling my toes was difficult and it felt like I had lost a lot of cognitive abilities,” says Ramirez. “But since my transplant, there hasn’t been a single day where I’ve taken a step back. Yes, it’s taken a mental and physical toll on my body, but even on my lowest days, I’m able to do a little bit more than the day before.”
On July 8, Ramirez was discharged from Northwestern Memorial and continued occupational and physical therapy.
“People need to understand that COVID-19 is real. What happened to me can happen to you. So please, wear a mask and wash your hands. If not for you, then do it for others,” adds Ramirez. “I also want other transplant centers to consider lung transplantation for COVID-19 patients. If I was in the COVID ICU at any other hospital, my care would have ended, and I wouldn’t be here today. I’m so grateful Northwestern Medicine didn’t give up on me and afforded me this second chance. The first thing I told Dr. Bharat after surgery was, ‘Thank you for saving my life.’”
Brian Kuhns: Second COVID-19 Patient to Receive a Double-Lung Transplant at Northwestern Medicine
Brian Kuhns, a 62-year-old husband and father, lives in Lake Zurich, Ill. He owns an automotive repair shop in Schaumburg, Ill., and first experienced COVID-19 symptoms in March. Kuhns complained of headaches, stomach pains and a fluctuating temperature. When he developed a cough, Kuhns went to a local emergency department on March 18. That was the last time his wife, Nancy, and their two daughters would see him for nearly four months.
“No one can prepare you for the emotional toll COVID-19 takes on a family. Not being able to see, touch or hold your loved one as they’re fighting for their life in the ICU is extremely difficult,” says Nancy Kuhns. “Before COVID-19, Brian was a pretty healthy guy who loved music, cars and making people laugh. But he also thought COVID-19 was a hoax. I assure you; Brian’s tune has now changed. COVID-19 is not a hoax. It almost killed my husband.”
Kuhns received the majority of his care at another health system before being transferred to Northwestern Memorial for consideration of a double-lung transplant. Before his name was added to the transplant wait-list, Kuhns had to test negative for COVID-19. Due to the extended support with ECMO, his body could clear the virus, providing the consideration of transplantation.
Within 72 hours of being listed, the transplant took place on July 5, which coincidentally happened to be the 100th day of ECMO support for Kuhns. Typically, a double-lung transplant takes six to seven hours, but this surgery took about 10 hours due to lung necrosis and severe inflammation in the chest cavities resulting from COVID-19.
“Prior to Brian’s arrival at Northwestern Memorial, he developed an invasive infection which required a major chest surgery. This was going to make the double-lung transplant substantially more difficult. When we opened the chest cavity there was a lot of evidence of infection; everything we touched or dissected started bleeding,” explains Samuel Kim, MD, a Northwestern Medicine thoracic surgeon who assisted Dr. Bharat during the procedure.
One day after surgery, Kuhns was off the ventilator and continues to recover at optimal pace.
“Everything happened so quickly. One minute I’m running my business, and the next minute I’m spending 100 days on a life support machine,” says Kuhns. “I’m extremely grateful for the care team at my original hospital who put me on ECMO, and I can’t thank the lung transplant team at Northwestern Medicine enough. Without them, I know I wouldn’t be here today. If my story can teach you one thing, it’s that COVID-19 isn’t a joke. Please take this seriously.”
Northwestern Medicine performs lung transplants on patients with all forms of end-stage lung diseases. Most patients eligible for lung transplants are dependent on oxygen to get through the day and suffer from conditions such as pulmonary fibrosis, cystic fibrosis, chronic obstructive pulmonary disease (COPD) or emphysema, scleroderma, interstitial lung disease, sarcoidosis, alpha-1-antitrypsin deficiency, pulmonary hypertension, amongst other advanced lung diseases, or are on a ventilator or ECMO. Following lung transplantation, most patients report complete independence in day-to-day life. For more information on Northwestern Medicine’s Lung Transplant Program, visit nm.org.
Photos and b-roll of both patients are available on Dropbox.