Breathing Easier After Lung Transplant

Richard Demien spent his life working as a paramedic, firefighter and as Cudahy’s fire chief. He loves to travel and spend time outdoors, so when he retired, he planned for many more adventures with his wife, Marla, and their nine grandchildren. But things changed in 2017 when Richard became increasingly short of breath. He was visiting friends in Alaska when he struggled to breathe on a hike.

“I was exhausted,” Richard said. “I had been coughing a lot and couldn’t breathe. That’s when I decided I needed to see my doctor.”

Limited Options for Treating Idiopathic Pulmonary Fibrosis

Richard’s primary care physician suspected lung disease and referred him to Linus Santo Tomas, MD, MS, pulmonologist and Medical College of Wisconsin faculty member. After imaging, pulmonary function testing and a lung biopsy, Dr. Santo Tomas diagnosed Richard with idiopathic pulmonary fibrosis (IPF), a progressive disease that causes lung tissue to thicken and scar over time and prevents the lungs from easily absorbing oxygen. IPF is one of the most common types of interstitial lung disease, and it can be difficult to identify the cause.

“Medication helps slow the progression of IPF, but there is no cure,” Dr. Santo Tomas said. “We can support patients with supplemental oxygen and pulmonary rehabilitation, but a transplant is the only curative option.”

Richard’s condition deteriorated significantly over the next few years, despite medication and oxygen therapy. In the fall of 2021, determined to bring his granddaughter to college in Arizona, Richard managed the trip using oxygen tanks and a scooter because he was too weak to walk. When he returned, Dr. Santo Tomas referred him to his colleague Alan Betensley, MD, transplant pulmonologist and MCW faculty member, to be evaluated for a lung transplant.

High Risk for Lung Transplant

Richard’s prior surgical history and age put him in a high-risk category for a lung transplant. A previous coronary artery bypass surgery on the left side of his heart could complicate the lung transplant procedure, but the team’s experience with complex cases, combined with Richard’s determination and strong support system, gave Dr. Betensley confidence that he would have a successful transplant and be able to recover.

“We did everything possible to reduce the risk factors we could control prior to transplant,” Dr. Betensley said. “We admitted Richard to the hospital to help him get stronger with the help of heated high-flow oxygen, which is oxygen that is warmed and humidified. It is easier for patients to tolerate and provides up to six times the flow than what is available through home oxygen therapy.”

Richard was so weak he could barely walk or speak, but with the oxygen and the help of his nurses and physical therapists, he was able to gain the strength he needed to be listed for a transplant.

“When I was feeling down, the nurses would help me stay motivated,” Richard said. “I fought as hard as I could to get ready for the surgery.”

Road to Recovery After Lung Transplant

Richard’s single lung transplant was done in October 2021 at Froedtert Hospital, the academic medical center of the Froedtert & MCW health network, by Nilto De Oliveira, MD, cardiothoracic surgeon and MCW faculty member. Dr. De Oliveira used a heart-lung bypass machine to support Richard’s left lung while he implanted the donor lung on the right side. After the procedure, to make it easier for the new lung to recover, Richard was put on an extracorporeal membrane oxygenation (ECMO) machine instead of a ventilator. This shortened the length of time he needed to be sedated and allowed him to walk sooner, which was crucial for his recovery. After two weeks in the intensive care unit, Richard was ready to be discharged to the inpatient rehabilitation unit. He went home the first week of December.

“The older the patient is, the higher the risk of complications because tissues are frailer, muscle mass is lower and heart and kidney function are weaker,” Dr. De Oliveira said. “Taking on a case as complex as Richard’s was only possible because of the experience and skill level of our transplant team.”

Richard is following a pulmonary rehabilitation program and getting stronger each day. He is planning another trip to Alaska, where he hopes to go moose hunting.

“I’m so grateful for the extra time, and I owe everything to my organ donor and their family,” Richard said. “I won’t let that person down. I’m going to live my life to the fullest.”