Heart and liver "travel" 300km to create miracle in Vietnam
Báo Dân trí•14/10/2024
(Dan Tri) - The heart and liver of a young man from Nghe An traveled 300km to save the life of a stranger, creating a "first-time" miracle in Vietnam.
On September 30, a 36-year-old man living in Yen Thanh district, Nghe An province unfortunately had a serious traffic accident due to a fall. The patient was immediately taken to Nghe An General Hospital for emergency treatment. Despite the efforts of doctors and nurses to save his life, the patient could not recover due to severe brain damage and was diagnosed with brain death. In indescribable pain, the patient's family made an extremely brave decision: Agreeing to donate their loved one's organs, with the hope that his life would continue through other lives. At the same time, in Hanoi, Mr. D.VH (41 years old) was on the verge of death, his life was kept alive by an artificial heart-lung machine (ECMO) and a series of other machines because his heart and liver had almost completely lost their main functions. Two years ago, Mr. H.'s life was completely turned upside down when he was diagnosed with end-stage heart failure (heart function was only 23%), due to dilated cardiomyopathy - atrial fibrillation. With each passing day, the man's body was gradually eroded by the disease. Ten days before he was admitted to Viet Duc Friendship Hospital, Mr. H. began to feel shortness of breath, chest tightness, abdominal distension and edema all over his body. During the treatment at the local hospital, Mr. H. did not respond, so he was transferred to Viet Duc Friendship Hospital. Here, during the treatment, Mr. H. was completely dependent on vasopressors and intravenous diuretics. The patient's condition worsened. By September 30, Mr. H. was in critical condition, his blood pressure dropped to a dangerous level of 70/50 mmHg, his skin was cold and clammy, and he was urinating little. Doctors in the Cardiovascular - Thoracic Intensive Care Department were forced to perform non-invasive mechanical ventilation to support his breathing. However, Mr. H.'s difficulty breathing continued to worsen. More dangerously, the patient also had acute liver failure and severe blood clotting disorders, with elevated liver enzymes. The patient was consulted by the entire center, and an emergency endotracheal tube was placed and emergency ECMO was set up. However, this was only a temporary solution to sustain life. Doctors determined that there was only one way to bring Mr. H. back from the brink of death: simultaneous heart and liver transplantation. With the family's consent, Nghe An General Hospital carried out the procedures in accordance with the law. At the same time, it reported to the National Organ Transplant Coordination Center. Upon receiving information from Nghe An General Hospital, the National Organ Transplant Coordination Center and Viet Duc Hospital immediately activated the "red alert" to implement the organ retrieval plan and prepare for an unprecedented surgery in Vietnam. Dr. Duong Duc Hung, Director of Viet Duc Friendship Hospital, called the decision to "activate" the first simultaneous heart and liver transplant a "difficult" one. "As soon as we received information that the patient agreed to the transplant, the hospital's professional council held an urgent meeting. Based on all the professional information about the patient's condition, we determined that this was a very difficult case to make a transplant decision. There were two things that made us cautious: The patient was too sick, at high risk, and this was a difficult transplant that had never been performed before," Dr. Hung analyzed. "If it was difficult, why did we still do it?", the Director of Viet Duc Friendship Hospital pointed out two core reasons: First, the hospital is confident in the expertise of its doctors and the ability to coordinate in the field of organ transplants, which has been honed over the past decades. Second, Dr. Hung emphasized that this decision reflects the consistent viewpoint of generations of Viet Duc Friendship Hospital that there is life, there is hope. "Even if there is only the smallest chance to save the patient's life, we will never give up," said Dr. Hung. A race against time began. From the afternoon to the night of September 30, the hospital continuously sent two teams to Nghe An General Hospital. On the morning of October 1, the team that supported brain death resuscitation and brain death diagnosis from Viet Duc Friendship Hospital and the National Organ Transplant Coordination Center, along with the teams from Nghe An General Hospital, carried out the removal of multiple organs (kidney, liver, heart, cornea) from the brain dead patient. Immediately after successfully removing the organs, the team from Viet Duc Friendship Hospital divided their forces. One group stayed behind to support Nghe An General Hospital in transplanting organs for two patients with end-stage renal failure. The remaining group rushed to "escort" the liver and heart over a distance of more than 300km to promptly transplant them into the dying patient. According to Dr. Hung, the heart and liver are the two organs with the shortest preservation time. Especially the heart, if not transplanted in time, the chance of success will decrease significantly. The ambulance sped straight to Hanoi to carry out its sacred mission: Lighting up a new life. Simultaneous heart and liver transplants are a particularly difficult challenge. We have had simultaneous transplants of two organs, but only heart-kidney or liver-kidney transplants. In international medical literature, only a few developed countries with advanced medicine such as the US or European countries can perform such transplants. According to Dr. Duong Duc Hung, organ transplants are extremely complicated major surgeries, the pinnacle of medicine, and are only performed when other treatment methods are no longer effective. "A heart or liver transplant is already very difficult. However, when transplanting these two organs at the same time into a very weak patient, the complexity increases not by two but by many times," Dr. Hung shared. The challenge comes right from the planning stage, when each step must be carefully calculated to optimize time. Even when the organ has been transplanted into the body but there is no blood in the organ, the risk of organ damage is very high. Dozens of doctors and nurses from many departments participate in the major surgery, which is likened to "a big battle", requiring the coordination of many military branches. "The testing team alone has nearly 10 people to perform all kinds of tests, in addition, the surgery requires many specialties such as: anesthesia - resuscitation, liver anesthesia, cardiac resuscitation, liver transplant team, heart transplant team... Each unit is like a "gear" in the machine, just a problem at any stage can lead to the failure of the whole campaign. Therefore, this battle requires the hospital's organizational coordination to reach a very high level of fluency. This is obtained from our two decades of accumulated experience in organ transplants", Dr. Hung affirmed. 14:30, October 1, inside the operating room of Viet Duc Friendship Hospital, the machine system is connected to closely monitor Mr. H's vital signs. The equipment and surgical instruments are carefully prepared and checked, ensuring the best conditions for the "big battle" that will last for many hours ahead. The simultaneous heart and liver transplant requires high concentration from the entire team. The doctors must remove the patient's dysfunctional liver and heart, minimizing damage, especially to the blood vessels. After that, the new heart and liver are transplanted. This process not only requires absolute precision in the operation, but also must be very fast. During the transplant process, doctors and nurses must also continuously monitor the patient's vital signs. Just a small mistake in controlling blood pressure, heart rate or blood flow can cause the transplant to fail. In addition, Anesthesia - Resuscitation is also one of the "fronts" that the Director of Viet Duc Friendship Hospital assessed as the most difficult in this great campaign. "Surgeons may only be stressed during 8 hours of surgery, but for the Anesthesia - Resuscitation team, the battle can last for many days," Dr. Hung analyzed. According to Associate Professor, Dr. Luu Quang Thuy, Director of the Center for Anesthesia and Surgical Resuscitation; Head of the Department of Intensive Care 2, Viet Duc Friendship Hospital, when transplanting 2 organs at the same time, the rate of rejection will be higher. "If a transplant rejection occurs, the liver will be affected immediately and may lead to immediate liver failure. Therefore, we must adjust the patient's immunity appropriately to prevent transplant rejection. However, a high level of immunosuppression creates another challenge: a higher risk of infection. Meanwhile, the surgical path for the patient is already very large, and the patient must undergo ECMO intervention immediately after the transplant. These are a series of difficulties in the recovery phase," Associate Professor Thuy emphasized. Late on the evening of October 1, the heart of the Nghe An man began to beat its first beats in a strange chest. His liver also began to function, secreting bile to help H.'s blood clotting index, liver enzymes and bilirubin gradually return to normal. The 8-hour brain surgery by doctors at Viet Duc Friendship Hospital helped a life be reborn from the liver and heart of a man who was about to leave this world. Through the post-transplant resuscitation process, on the afternoon of October 5, Mr. D.VH had his endotracheal tube removed and began to practice breathing on his own. Gradually regaining consciousness, the 41-year-old man smiled, expressing his gratitude to the "stranger" who helped him write the next pages of his life. According to Dr. Duong Duc Hung, the success of the simultaneous heart and liver transplant for a patient is a proud new milestone in the field of organ transplantation in Vietnam. This expert emphasized that this success is not only the pride of Viet Duc Friendship Hospital, but also affirms the remarkable progress of the country's health sector, thanks to the proper investment of the Party and State as well as the determination of doctors. "We have every right to be proud of Vietnam's organ transplant technique, which is on par with the world's medical powers. Even many more developed countries with more advanced medical systems than Vietnam still cannot perform this technique," Dr. Hung shared. On the patient side, this success opens up the opportunity for many patients with heart failure and liver failure who are on the brink of death. As a leader in the field of organ transplantation, having mastered this technique, Viet Duc Friendship Hospital can transfer it to other medical facilities across the country, helping to multiply these extremely humane major surgeries. "The patient's donated organs are priceless gifts. We are the ones who bring this gift to the recipient. Over the years, Viet Duc Friendship Hospital has always strived to transfer the technique of organ retrieval and transplantation to other medical facilities to spread this noble gesture. Many provincial hospitals, after being "held by the hand and shown the way" by Viet Duc Friendship Hospital, have been able to perform organ transplantation such as: Phu Tho Provincial General Hospital, Vietnam - Sweden Uong Bi Hospital, Nghe An General Hospital, Xanh Pon General Hospital..., lighting up many lives", Dr. Hung shared.
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