UF Health MedMatters

The Lungs That Led: How Early COVID-19 Lung Transplant Patients Helped Create Lifesaving Protocols at UF Health

Melissa Buchanan pushing her husband on a wheelchair in a hallway.When Melissa Buchanan’s husband could no longer breathe on his own, she thought they’d hit rock bottom.

Then, the bottom got deeper.

“The doctors met with me and told me that I needed to think about letting my husband die peacefully and not catastrophically,” Melissa said.

2 Months Prior

From January to March 2021, the lung transplant program at UF Health Shands Hospital performed more lung transplants to treat patients whose lungs had been damaged by COVID-19 than anywhere else in the United States, according to data from United Network for Organ Sharing.

Patients like Mark Buchanan, who fell ill with COVID-19 in early August of 2020, paved the way.

At first, Buchanan, 53, was just mildly ill. Then, he deteriorated.

“At the time, he just went (to our local hospital) thinking he was going to get the medicine they were giving, maybe fluids, and come home,” Melissa recalled.

Three days later, the father of two was intubated in Carrollton, Georgia. From there, things moved quickly.

Mark’s care team transferred him to a larger hospital, where he was placed on life support and extracorporeal membrane oxygenation, or ECMO, a technique that allows injured lungs to rest and recover by filtering carbon dioxide from the blood and oxygenating it as it passes through a mechanical lung.

Each time his health care team attempted to wean Mark off of sedation to see if he could breathe on his own, his oxygen levels dropped. Doctors were sure there was nothing more they could do.

But Melissa wasn’t.

As her husband’s condition worsened, she took it upon herself to investigate any and all treatment options — including lung transplantation. At the time, doctors nixed the possibility. Mark’s inability to participate in physical therapy while on ECMO, a requirement for candidates to be added to the organ transplant wait list, left a transplant out of the question.

“Looking back, it all happened so fast,” Mark said. “And you have to keep in mind I was unconscious for a lot of it. In some ways, it was harder on Melissa, because she had to see me like that.”

Conversations about her husband’s supposedly inevitable death left Melissa emotionally spent and physically exhausted. But she was also determined, and leaned on friends and family who helped with her search for alternative treatment options.

“I put it on Facebook. I called every physician. And, then, I called friends,” Melissa remembered. “We had friends calling and telling us, ‘Have you tried this place?’”

At first, it was a series of dead ends.

Then, Melissa’s niece, a technician who works in a catheterization lab at their local hospital, reached out to a physician she worked with to ask for his advice.

The physician’s brother attended school and previously worked with the medical director of UF Health’s lung transplant program, Andres Pelaez, MD. After learning of the case, Pelaez and Tiago Machuca, MD, PhD, chief of thoracic surgery and surgical director of the UF Health lung transplant program, called Melissa.

“If we believe a patient has potential to be a candidate, we will go above and beyond to give them that second chance,” Machuca said. “Our lung transplant program has grown into a team that can treat some of the most complex cases with great outcomes.”

Back in Georgia, Mark’s doctors began to discuss removing him from life support.

“I was able to ask Mark, ‘Are you tired of fighting? Have you given up or do you want to keep fighting?’” Melissa recalled. “And, of course, he couldn’t talk, but he could move his head for ‘yes’ and ‘no.’ He wanted to keep fighting.”

And as long as Mark wanted to fight, so would Melissa.

“(Mark’s care team) said, ‘There’s nothing that can be done. I don’t know why you’re doing that.’” Melissa said. “Machuca and Pelaez decided they would give Mark a chance and go get him.”

UF Health’s lung transplant program has developed a reputation for performing transplants when no one else will. Over the last seven years, Machuca has seen the small program transform into something incredible. Part of the program’s success is due to the fact that it operates in a dedicated thoracic unit, routinely cohorting focused expertise, Machuca said.

“Now, patients who have lung failure and need lung transplants, ECMO support and complex thoracic surgeries are treated and cared for by a team who does this every day,” Machuca said. “By this point, we’ve seen almost every kind of lung transplant case you could think of — even in the sickest of patients.”

After losing nearly 70 pounds, it was imperative that Mark regain his strength to qualify for lung transplant candidacy. With the help of his physical therapists, Mark progressed from standing to walking and was waitlisted.

“They kept saying, ‘You’re going to be fine. You’re going to get your lungs.’” Melissa recalled. “So we had hope.”

Twenty days later, Mark’s lungs arrived.

“It was the scariest thing of my life,” Melissa said. “They (the care team) were very compassionate and, you know, they see it every day, so they were able to get me calm.”

Helping patient families through those moments of uncertainty is a cornerstone of transplant, Machuca said. But he tries to remember the big picture.

“This pandemic is opening a new window of opportunity for patients with lung failure,” Machuca said. “For other etiologies of lung failure, a lot of things we are doing now could be translated to other advanced lung diseases and lead to positive outcomes. We try to think what good can come out of all of this, because it’s been hard on everyone.”

After transplantation, Mark began his rigorous road to recovery. By the end of November, Mark was walking with assistance and began inpatient rehabilitation shortly after, staying until Jan. 3, when he was discharged to outpatient rehabilitation.

Like many others, he and his family are still adjusting to a new normal.

“It’s not just his life that’s changed. All of our lives have changed,” Melissa recalled. “Family has been the biggest thing. Prayers. Friends. We have a great support system.”

Back at their home in Georgia, Melissa and Mark intend on taking life day by day.

“We’re going to enjoy every day that we have.”

About UF Health Shands Hospital

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University of Florida Health Shands Hospital has been recognized among the nation’s best hospitals in seven adult medical specialties. Overall, UF Health Shands Hospital was recognized as one of the best hospitals in Florida. In addition to being ranked among the nation’s top 50 hospitals in seven specialties, UF Health Shands Hospital also was listed as “high performing” in seven specialties, including abdominal aortic aneurysm repair, colon cancer surgery, COPD, heart failure, lung cancer surgery, neurology & neurosurgery and orthopaedics.