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© St. Petersburg Times, published July 16, 2002
TAMPA -- For 35 years, Robert Carr was a Marlboro man. If that wasn't bad enough for his lungs, he said, he spent decades installing house alarms in attics with fiberglass insulation.
By his late 40s, Carr was gasping and wheezing. By his mid 50s, he was relying almost entirely on a ventilator through a hole in his throat.
But on Monday, Carr sat before a crowd at Tampa General Hospital, a new man.
A month ago, two lungs from a cadaver were implanted in his chest, making him the hospital's first lung transplant recipient. Two other patients at TGH have successfully undergone the operation, the last on Friday night.
"It made me feel like a human being again," Carr, 56, of St. Petersburg said.
Lung transplants are the latest addition to TGH's extensive transplant program. The hospital offers more heart and combined kidney and pancreas transplants than any institution in Florida. TGH doctors also replace livers.
"We're looking forward to making this one of the leading lung transplant programs in the country," said Mark Rolfe, a pulmonologist at University of South Florida College of Medicine and member of the TGH lung transplant team.
Lung transplants have been performed along with heart transplants since the late 1960s, but the procedure was reinvented in the 1980s, said Fraser Keith, who co-heads a collaborate team of surgeons and physicians from TGH and LifeLink Transplant Institute in Tampa.
Seventy-five medical institutions throughout the country offer the procedure, but only in three in Florida, including Jackson Memorial Hospital in Miami, St. Luke's Hospital in Jacksonville and Shands at the University of Florida in Gainesville. Those hospitals performed about 40 lung transplants last year.
The lung program at TGH will mean more such operations, which are badly needed. But doctors are limited by a shortage of suitable donors.
Three times as many people are awaiting lung transplants as there were operations last year, according to the United Network for Organ Sharing. In Florida, 168 people qualified for lung transplants as of two weeks ago, the organization says.
The organs Americans need most are kidneys. About 52,000 people are on kidney waiting lists in the United States -- more than all other organs combined.
But doctors say a third of lung transplant candidates die while awaiting lungs.
"They are much more likely to die on the lung waiting list than the heart waiting list," Keith said.
Lung transplants are not particularly technical, doctors say. An uncomplicated operation takes up to six hours.
But lungs are fragile. They must be implanted quickly after death and are susceptible to infection. Long-term risks include rejection by the body, which can be deadly. About half those who receive lung transplants die within the first five years, Keith said.
Viable hearts are easier to come by than lungs. After death, the first organ to deteriorate is the brain, then the lungs. A cadaver's lungs often are too diseased or injured for a transplant.
What's more, lungs, like hearts, must be transferred within six hours of death. By comparison, livers don't expire until up to 18 hours of death, and kidneys, 24.
Cadavers are the main source of organs, although live donors are increasingly asked to donate their organs to save family members or friends.
TGH doctors said they might eventually operate on live donors. For now, the goal is to accomplish 10 lung transfers a year, the minimum number required before Medicare is willing to pay for the operations at any given hospital.
LifeLink spokeswoman Ruth Duncan Bell said lung transplant operations average about $210,000.
Doctors at TGH screened about 25 patients for the three operations they performed. Cancer patients were eliminated because of concerns that the disease had spread to other organs. Health insurance companies rejected requests by some candidates. Seven patients are on TGH's waiting list.
The second person to receive a lung through the program was Shirley Smith, 63, of Frostproof. She smoked and worked on farms her whole life, she said. Lately, her breath was so labored that the mother of seven carried around an oxygen machine.
The transplant on June 24, five days after Carr's, was a success. She can walk again with ease. And talk.
"Before the operation," she said, "I didn't have a life."
-- Kathryn Wexler can be reached at wexler@sptimes.com or (813) 226-3383.