UAE’s first combined heart and double lung transplant saves Emirati woman, 56, in critical condition

Patient lost 30kg, couldn’t breathe, undergoes 8-hr surgery at Cleveland Clinic Abu Dhabi

Abu Dhabi: A 56-year-old Emirati woman, suffering from a congenital heart disease, has become the recipient of the country’s first combined heart and double lung transplant, the hospital that conducted the pioneering surgery announced on Tuesday.

Doctors at Cleveland Clinic Abu Dhabi, part of the M42 group, raced against time to perform the eight-hour complex transplant surgery to save the life of the woman whose health had deteriorated to such a critical point that she had lost over 30kg and was struggling to breathe.

The patient’s medical journey began in 2004 in the US, where she was diagnosed with an atrial septal defect (ASD), a congenital heart problem, the hospital said in a press release.

Over the years, the untreated ASD led to increasing pressure in her heart leading to pulmonary hypertension. The woman’s journey had spanned years and continents. She had undergone various treatments at hospitals around the world, but nothing had halted the steady progression of her disease. By the time she arrived at Cleveland Clinic Abu Dhabi in March 2022, her heart was severely enlarged, and her lungs could no longer function properly.

Multidisciplinary team

Explaining the patient’s condition, Dr Fadi Hamed, consultant pulmonologist and medical director of lung transplant programme at Cleveland Clinic Abu Dhabi said, “The patient was regularly monitored for response to diverse care and therapeutic strategies to tackle the issue but showed no progress with standard medication. The deterioration continued so a multidisciplinary team was formed and deployed to assess her condition.”

Doctors realised that her condition was far too complex for a standard lung transplant and she needed a combined heart and double lung transplant, a procedure that had never been performed in the UAE before.

Dr Mitesh V. Badiwala, Staff Physician in Cardiothoracic Surgery at the Heart, Vascular and Thoracic Institute, explained: “In modern history, pulmonary hypertension is typically treated with a lung transplant. However, the patient’s condition was particularly challenging due to her severely enlarged heart and petite frame, necessitating a combined heart and double lung transplant. If the congenital defect she had [been diagnosed with] in 2004 had been treated earlier, she might not have suffered such severe deterioration.”

As her condition continued to deteriorate, the medical team at Cleveland Clinic Abu Dhabi raced against the clock. By February 2024, her body had stopped responding to medication, and she was struggling with severe water retention, dangerously high blood pressure, and breathing difficulties. Survival beyond a few months without surgery was unlikely. She was admitted to the ICU, where doctors worked tirelessly to stabilise her until suitable donor organs became available.

Complex

Dr Nadya Almatrooshi, a Staff Physician in Cardiothoracic Surgery, highlighted the meticulous preparation involved and said, “Cleveland Clinic Abu Dhabi is one of the few hospitals that facilitates multidisciplinary care for complex cases. Teams from different departments worked tirelessly to manage her heart pressure by keeping her on high oxygen in the ICU until suitable organs were available.”

A multidisciplinary team of cardiology, heart failure team, pulmonology, thoracic surgery, cardiac surgery, cardiac intensive care and cardiac anaesthesia was involved in the meticulous planning for the combined heart and lung transplant.

Matched organs

Dr Usman Ahmad, Department Chair of Thoracic Surgery, who has previous experience with combined heart and lung transplants in the US, noted the urgency of the situation: “The patient was at the end stage of heart and lung disease. Had we not found the matched organs in time, she could have lost the window of opportunity for this life saving surgery. The decision to proceed with the combined transplant was a significant milestone for both the patient and the team at Cleveland Clinic Abu Dhabi.”

The transplant was performed by a team of four cardiothoracic surgeons, two cardiothoracic anaesthesiologists, five cardiothoracic specialised nurses, two perfusion experts and took over eight hours due to the complexity of her anatomy. The team led by Dr Ahmad and Dr Badiwala connected her to the heart-lung bypass machine, removed her diseased heart and lungs and implanted the new organs which started working very well immediately.

Post-surgery, the woman remained under close observation in the ICU, where her recovery was monitored around the clock. Today, the woman’s life has been transformed, and she remains grateful for the milestone transplant which offers hope for other patients facing complex, life-threatening conditions.

Uncommon even internationally

Dr Ahmad explained: “Combined heart-lung transplant operations are uncommon even in large volume international transplant centres. Our programme is unique due to short wait times, access to appropriate size-matched organs and short ischemic times. The time that donor organs are outside the body, awaiting transplant is called ischemic time and longer ischemic times can lead to worse outcomes after transplant. Under the guidance of Department of Health- Abu Dhabi and in collaboration with Hayat (the National Programme for Donation and Transplantation of Human Organs and Tissues), we are able to keep the ischemic time short for heart and lung transplant. This has allowed us to achieve outstanding survival results in these complex surgeries and because of such complex surgeries that we can do here, we are now seeing patients from Europe, Asia and South America,” Dr Ahmad added.

With the milestone procedure, Cleveland Clinic Abu Dhabi has added to its life-saving accomplishments as the UAE’s first multi-organ transplant centre. Since its inception in 2017, the hospital said it has performed over 700 transplants, including 47 lung transplants and 23 heart transplants.

Exceptional healthcare system

Dr Rashed Obaid Alsuwaidi, the Executive Director of the Healthcare Workforce Planning Sector at DoH said: “Abu Dhabi has significantly enhanced its organ transplantation capabilities through its exceptional healthcare system, advanced infrastructure, and skilled professionals. These elements work together to ensure that organ transplantation services adhere to international best practices and utilise the latest technologies and innovations. Since the launch of Hayat in 2017, Abu Dhabi has experienced a consistent increase in organ transplant procedures, exceeding 800 operations by the end of 2023, contributing to saving and improving the lives of many patients.”

1,000 transplants

According to the latest figures released by the Ministry of Health and Prevention, the UAE has successfully performed 1,000 transplants since the launch of Hayat programme. The International Society for Organ Donation and Procurement has recognised the UAE as the fastest developing nation in organ donation globally. Leading the Gulf countries in this vital area, the UAE boasts a donation rate of 9.1 donors per a million population, significantly ahead of Saudi Arabia at 4.08 and Kuwait at 7.67, thanks to the country’s efficiency of the health system and the advanced human and technological capabilities.