From Baylor University Medical Center, Dallas, Texas.

Corresponding author: Mary Moore Free, PhD, house biomedical anthropologist, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, Texas 75246.

Mr. Gaillard, a South Carolinian, had gone to Clemson University on a football scholarship. While both of his knees suffered playing field injuries, he was otherwise in excellent health at that time. Some 25 years later, however, he was suffering from end-stage emphysema resulting from alpha1-antitrypsin (A1-A) deficiency. He arrived at Baylor University Medical Center on August 3, 1989, for evaluation for lung transplantation. On July 28, 1990, he became Baylor's first lung transplant recipient. His personal account of his single lung transplantation experience follows:

On June 6, 1979, I was hospitalized with pneumonia. I was 36 years old. My problems with energy came on gradually. For example, after I left the hospital, I noticed that it was hard to do stairs and other walking. I thought this was maybe due to smoking. I cut back. Then after my diagnosis of lung failure and the recommendation to have a lung transplanted, I wondered if smoking sped up my condition and had necessitated my being transplanted sooner. Anyway, I knew something was really wrong.

I went to Dr. Robert Galphin, a pulmonologist in Columbia, South Carolina. He diagnosed my A1-A condition. He said that trypsin acts as a sponge and gives lungs pliability, that my trypsin deficiency was genetic, and that there was nothing to do but have a heart/bilateral single lung transplant (H/BSLTx). I continued to work until 1986. It got so that I could hardly move around. I had to quit work and I got disability. I could get around just a little bit. Then in 1989, I heard that a South Carolina congressman, by the name of Floyd Spence, had a H/BSLTx, in Oxford, Mississippi. I called the surgeon and got all the information.

After I talked to the surgeon, my mother and my sister drove out to Dallas to talk to my cousin. She had 3 sons born at BUMC, and she offered to call and find out about its transplantation program. She had heard about it in the news. That call hooked them up with Dr. Peter Alivizatos (Dr. A.). After that, I called Dr. Richard Laurens in Greenville, South Carolina, to tell him BUMC had a program. Next, Sue Washington, RN, the cardiothoracic transplantation coordinator at BUMC, called me at home to tell me to come on out.

On Sunday before the drive to Dallas with my wife, my sister-in-law, and her husband, I got up and looked out the window and saw a Toronado in the garage. My son had won the use of that car, for 3 months, in a golf tournament. He told me to drive that car to Dallas and to have a nice trip. That car made it a nice trip. From then on, I stayed at BUMC's hotel. My clothes were sent out here from home.

Before the transplant, I had to be brought down in a wheelchair, from the 12th floor to the third floor of Wadley, for rehabilitation (Figure 2). Otherwise, I was stuck in my room and I was depressed—I had to sit down several times on the walk to the cafeteria for meals. The physical therapist got a cart for me. I also moved to the second floor. That room was by the ice and cold drink machines, and I could get around in the cart to get them. But I wanted something to do. I was bored, discouraged, depressed, with no friends, and 1000 miles from home. I did not want to bother the other people working in the hospital by talking to them because they were all busy, but I wanted to do something.

I was put in touch with the volunteer office and, after an orientation, I became a full-fledged Baylor volunteer. Even though I did not really know what it was all about and I was one of very few male volunteers, I “worked” 4 to 5 hours per day for 5 days per week. The more I became involved, the more I did. I won the 5-Star Spirit Award. I operated the tel-med: I answered the phone and played tapes of diseases. This work changed my life during the wait for a lung. I got up early every morning, worked out, and could not wait to go on to work. I liked helping people. One good example is the day a woman called to hear the tape on uric acid because her gold ring turned her finger green; I told her, however, that I myself had a fix for that and it was to quit buying her rings at K-Mart and she laughed.

The weekends were long at first, but it became enjoyable later. I developed some friends and I could go out with them. Soon I knew everybody. I visited at the hotel desk. On my birthday—April 29, 1990—I had a false alarm: the lung that was offered was no good. I was not too disappointed—I felt it was no big deal. And anyway, I was given a birthday cake.

While I was waiting: During the first 3 months, I worried about somebody's dying so that I could live. Acceptance comes. And during the second 3 months, I decided that this was the way it had to be. Maybe it was preordained. During the third 3 months, I really wished it would happen. I was ready. By the fourth 3 months, I was ready to get a stick and go out and find my own donor.

Then came the day! It was a Saturday. My donor was 18 years old. I still get edgy every month or so just thinking about that. My wife and mom flew out to Dallas from home. It was my wife's first time to fly, but she said she had no choice. Albeit Dr. A. had done pig lungs, he said to me that he had never done a human lung. I told him, “That makes two of us!” And then! there I was in the OR hall in sanitized splendor: I had been bathed 3 times!

The third day posttransplant in the ICU, my blood pressure dropped to 30/20. My native lung had blown out due to too much ventilator pressure. Dr. A. called Dr. Black to the ICU, and they opened my chest and let the air out. I had no anesthetic and it hurt! I opened my eyes and there was Dr. Ramsay who said, “This is no problem—just routine. We are going in (the OR) and fix you.”

The next thing I remembered was that I was extremely thirsty. But that tube was down my throat and I could not drink or talk. So I had to write to communicate. I am left-handed, but for unknown reasons, my right-handed writing was completely legible. Then, they switched the art line to my right arm and I could write with my left hand, and someone remarked that I wrote very legibly with my left hand. I got morphine from a nurse, and Dr. A. went ballistic. The nurse said, however, that she would do it again.

Dr. Shuey came in the ICU and said, “What do you think about the respirator?” I wrote, “What do you think I think about it?” They had to try 4 times to get me off the respirator. They woke me up to tell me that I was breathing on my own and, then, I could not. I did not like their lack of scheduling and the work on the respirator. I asked them to take the clock away so that I could not see it—it never moved. I was in the ICU for 64 days posttransplant, and I was on the ventilator for 63 of those days.

In early September, Dr. A. went to Greece. I thought, “He is going to Greece and he is not going to be here when I die.” But Dr. A. said I would be in the hotel when he returned. Wrong! I was still on the respirator when he got back. That worried Dr. A., who said, “Gene has come so far. I do not want to fail now.” After being suctioned every 30 minutes one night, I wrote, “Take the vent out!” They did and that was the end of it. Soon after that, the ceiling leaked over my head. Dr. Tom Myers came in and gave me a “Healing Force” umbrella. He said, “The Healing Force of Texas is taking care of you.” He was right!

You lose all modesty in the ICU. I sat on the potty-chair in front of the world. Then one day, I finally said, “I can sit in a chair. Put me in one and put the bicycle in front of me.” I invented this bicycle thing and it is now standard. I also saw myself on public television. The whole thing was on PBS.

Care here/caring here—there is a difference in the two and you get both at Baylor. I know that I could not have survived in any other environment. The medical and administrative staffs are all involved for the patients' welfare. I had to be careful about saying what I liked or what I would like to have because it happened. For example, I wanted pinto beans and cornbread and I got them right away. And they also brought buttermilk!

The number one most important thing that made me make up my mind to have the transplant was that I knew I was going to die sooner or later and that a lot of the timing of that was up to me. The negative thoughts about dying had to be put out of my mind; my chance of living with end-stage lung disease was nil. So I thought, “Die on the operating table if I must, but I must give it my best shot to live.” While it is true that my family was not optimistic about my survival—even with the transplant—I told them that I had to take the chance. I said, “I will not be home until after the grand opening—the grandest opening I have ever or will ever be involved with—and I have to do what I have to do.”

I weighed all the options of how the transplant would or could affect my family and myself. When I settled that, I decided that I needed a positive attitude and a sense of humor. Before I got the new lung, I never used my oxygen tank because I felt it was a symbol of giving up. And claustrophobia was a problem—I always kept the curtains open so I could see out of the windows. I wanted light, openness. I took very hot baths to relax and get to sleep. Then I would wake up smothering.

Well, after I got my new lung and I was well enough to be discharged and I could go home, I found that I was a conversation topic. I was asked to do a lot of speaking. And I did. I have only been in the hospital once since my transplant, and that was when I had phlebitis because I took myself off of Coumadin. I will not do that again.

To sum it all up, I have had to do my posttransplant course my way. I do not brag about having a new lung. I think a lot of the posttransplant problems that develop are because one pays too much attention to oneself. But the bottom line is that I am fixed (Figure 3).

Current data from the United Network of Organ Sharing (UNOS) show that every 16 minutes a new name is added to the list of candidates for solid organ transplantation. At the present time, UNOS data show that 67,340 men, women, and children are listed for solid organ transplants. From the beginning of 1985 until the middle of 1999, 6887 single lungs have been transplanted in the United States, with 95% of these procedures having been carried out since January 1, 1990. Moreover, in contrast with male-dominated heart transplantation (77%), women have received most of the lung transplantations (58%).

While other factors (e.g., age and social situation) are considered, bilateral single lungs are transplanted in patients who have suffered the ravages of recurrent respiratory infections caused by diseases such as cystic fibrosis and bronchiectasis or when cultures demonstrate the presence of fungal or panresistant infection. Pulmonary hypertension is another indication for bilateral lung transplantation. Unilateral single right or single left lung transplantation is performed on patients with idiopathic pulmonary fibrosis or emphysema, including A1-A deficiency.

Because life is dependent on the physiology of vital solid organs and tissues, quality and duration of life are limited for these people when these organs and tissues fail. Thus, the only reason to perform solid organ or tissue transplantation for patients who develop end-stage disease(s) of vital solid organs or tissues and who seek and qualify for this procedure is to increase both the quality and the duration of their lives. To this end, patients referred to BUMC for cardiothoracic transplantation must undergo extensive assessments in medical, psychological, and social services, as well as transplant financial reviews. These data are interpreted by the members of the transplant selection committee, and patients cleared for transplant are listed by UNOS. Vital solid organs that are transplanted at BUMC include the heart, lung, liver, kidney, and pancreas.

This article has briefly reviewed transplantation of the lung and has presented, in his own words, the transplant experience of Mr. Gaillard.

Acknowledgments

The author gives special thanks to Ken Ausloos, MD; John E. Capehart, MD; Gordon Hosford, MD; and W. Steves Ring, MD.