Tim Sauvé has few memories of the hours before he was wheeled into a Toronto operating room for a double-lung transplant.
Weak and in pain, his lungs irreversibly damaged from COVID-19, Sauvé understood little except that the surgery offered a final chance at life.
The then-60-year-old had been in hospital since mid-December after collapsing in his Mississauga condo the same day he tested positive for COVID-19. Though he had survived the viral infection, the disease had ravaged his lungs and a sophisticated life support machine was keeping him alive.
“I was praying I’d be a good candidate for a transplant and tried to have hope up until the last moments,” Sauvé told the Star. “I didn’t know until after I woke up that I was the first.”
Physicians at University Health Network believe Sauvé is the first person in Canada to receive a double-lung transplant after becoming ill with COVID-19.
The milestone procedure, which took place at Toronto General Hospital in February, offers a chance of recovery to a small number of COVID-19 patients — those who are younger and previously healthy — who would otherwise die of the disease.
“When there is very obvious destruction of the lungs — when we don’t think the lung will ever recover, but they are well from every other organ perspective — that is a situation where we would consider transplantation,” said Dr. Marcelo Cypel, surgical director at the Ajmera Family Transplant Centre at UHN and the doctor who performed Sauvé’s transplant operation.
With the third wave fuelling an increase in the number of younger patients getting severely ill with COVID-19, UHN physicians say they expect to do more lung transplants due to the disease.
But they caution the total number of lung transplants will be small compared to the millions of COVID-19 cases recorded in the pandemic. And only those patients who, after undergoing careful assessment, are deemed strong enough, and who have no other organ damage, will be considered for a transplant.
Worldwide, about 50 COVID-19 patients have so far undergone lung transplants. As of Sunday, two COVID-19 patients are on the wait list for a lung transplant at Toronto General: The most recent one was listed on Friday, with another to be listed this week, Cypel said.
“It’s a very, very small subset of patients,” he said. “Our priority is to get a patient’s own lungs better. But for the few patients who won’t get their lung function back, this is an important option.”
Sauvé doesn’t know where he got infected with the virus that causes COVID-19.
Up until his illness, he had been working at a printing shop and was preparing to start at a new company on Dec. 14. Sauvé attributes his four decades in the industry — the long days of lifting paper and pushing equipment on the shop floor — for his good physical fitness at the age of 60.
“I thought even if COVID strikes me, it won’t last long; I was strong and I thought I’d get over it quickly.”
At first, his symptoms were mild — headache, dizziness, a little bit of breathlessness — and Sauvé suspected a cold. But by Dec. 14, he developed a fever and learned he had tested positive for COVID-19. That same day, he collapsed and was taken by ambulance to Mississauga’s Trillium Health Partners.
Once in hospital, Sauvé was first given supplemental oxygen and then, as his levels dropped, put on a ventilator. His partner, Julie Garcia, her son and her father also tested positive for the virus. At one point, Sauvé and his father-in-law were in neighbouring ICU rooms; Mr. Garcia later died.
Though Sauvé survived, his lungs were permanently damaged. He was diagnosed with pulmonary fibrosis — a lung disease caused by a buildup of scar tissue that affects how the organ functions — and was told he had a limited time to live.
“When I heard that, I became numb to everything around me,” he said. “I researched (the condition) online and it looked pretty hopeless.”
But since Sauvé had no underlying medical conditions and his other organs were still functioning well, physicians believed he was a candidate for a lung transplant.
He was transported to Toronto General, where he was quickly placed on an extracorporeal membrane oxygenation machine, or ECMO, which pumps the patient’s blood outside of their body, removing carbon dioxide and adding oxygen, before sending it back into a vein near the heart. The life support machine gives lungs time to rest and heal.
Cypel, surgical director of UHN’s Extracorporeal Life Support Program, said it was clear Sauvé’s lungs would not heal due to the extensive buildup of scar tissue, even after being on ECMO.
“Normally, lungs move very easily; like if you blow up a balloon, there is very little resistance. But a lung with fibrosis becomes very stiff.”
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Transplant surgeons told Sauvé about the risks and long-term implications of getting new lungs, including the months of rehabilitation and the need for immunosuppressive drugs.
After medical tests confirmed he was a good candidate, Sauvé was put on the wait list for lungs and in February underwent the eight-hour operation. (The Star has not included the date of Sauvé’s transplant to protect the donor’s anonymity.)
Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program, the largest of its kind in the world, said a transplant is not a cure for COVID-19 and should only be used in “exceptional circumstances” when the lungs are no longer viable, and the patient is deemed strong enough to pull through the surgery.
“The question is: When is your window of opportunity to do the transplant — that point at which you know the lung is definitely not recoverable, but the surgery is still doable and will provide a good result?” he said.
In addition to medical considerations, Keshavjee said it’s important a patient fully understands the risks and benefits to such a surgery, adding that not everyone wishes to undergo a transplant operation. Gaining first-person consent in such instances is critical, he said.
Since donor lungs are already scarce, there are concerns adding COVID-19 patients with lung failure to wait-lists — here in Canada and around the world — will mean others won’t get the life-saving surgery.
But Cypel said COVID-19 patients are just as deserving as others waiting for new lungs and, for now, will not significantly increase wait times.
“These patients didn’t choose to get sick with COVID-19,” he said, noting there are about 70 people currently waiting for new lungs in Ontario. “We’re talking about adding a few new people, so it won’t have a huge impact.”
Keshavjee said the Toronto Ex Vivo Lung Perfusion System, a device he co-developed with Cypel, is routinely used to repair donor lungs previously unsuitable for transplant. It has doubled the number of lung transplants the hospital does each year; Toronto General did 212 lung transplants in 2019, he said.
Sauvé, who spent weeks recovering at Toronto General, was transferred on April 1 to UHN’s Toronto Rehab Bickle Centre.
Dr. Alexandra Rendely, a physical medicine and rehab specialist, said she will likely always remember the moment she first met him.
“He was sitting up in bed and smiling; he wasn’t on any oxygen,” she said, adding she continues to be amazed by the life-saving results of transplant surgery. “He had already worked hard to get to this point to be safe and ready for rehab. I just had a feeling he was going to do well.”
Lung transplant recipients work with a team of specialists, including respiratory therapists, to improve their lung function and recover their strength and mobility after extended hospital stays. As well, transplant recipients often have to adjust to their new organ, including taking new medications that come with their own side effects, Rendely said.
“We really try and work with our patients to figure out what’s going to be important to them and work on their goals,” she said, noting Sauvé’s biggest wish is to get quickly home, which will likely happen later this spring.
“We’re hoping to add life to the years that these new lungs and transplant have afforded him, and help him enjoy life again and be able to get back him back home.”
In these first few weeks at the Bickle Centre, Sauvé, now 61, will focus on rebuilding and strengthening his muscles after lying in a hospital bed for 3 ½ months.
Before being transferred for rehab, Sauvé only sat in a wheelchair a short time each day. Now, he sits in it for two or three hours, using his feet, and not his hands on the wheels, to propel himself forward.
“I let my feet do the pushing,” he said. “I dig my heels into the ground and push, one step and a time, to exercise my legs and my feet. I can feel it working.”
On Friday, during his daily rehabilitation exercises, Sauvé stood for the first time since being rushed to hospital in mid-December. Three times in a row, with breaks in between, Sauvé stood for between 15 to 20 seconds, with staff holding his lower legs to ensure he didn’t fall over.
“Every day I’m making progress,” he said. “They asked me on my first day for my goal. My goal is to walk out of here on my own two feet and go back to my beautiful partner and to be with her again.
“Even though this is hard, I’m appreciating every moment I’m alive. Prior to COVID, like everyone else, I took things for granted. But now I’m not wasting a moment.”
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