Cleveland Clinic Abu Dhabi performs UAE’s first combined heart and double lung transplant

• The combined heart and double lung transplant was performed on a 56-year-old Emirati patient as Cleveland Clinic Abu Dhabi continues to perform complex, life-saving care in the UAE countering the need for treatment abroad • Cleveland Clinic Abu Dhabi is the first multi-organ transplant center, offering cutting-edge and compassionate care from the initial planning stages through to post-transplant follow-up

Cleveland Clinic Abu Dhabi, part of the M42 group, has successfully performed the first-ever combined heart and double lung transplant in the UAE, underscoring the hospital’s commitment to advanced medical care. The complex surgery was performed on a 56-year-old Emirati woman who was suffering from pulmonary hypertension - a life-threatening condition caused by high pressure within the pulmonary artery, which disrupts the vital flow of blood from the heart to the lungs.

Cleveland Clinic Abu Dhabi achieved this milestone with the support of the Department of Health – Abu Dhabi. This accomplishment reflects Abu Dhabi's commitment to becoming a leading global healthcare destination, driven by its advanced transplant capabilities, state-of-the-art infrastructure, experienced healthcare professionals, and world-class facilities.

With the milestone procedure, Cleveland Clinic Abu Dhabi has added to its life-saving accomplishments as the UAE’s first multi-organ transplant center. Since its inception in 2017, the hospital has performed over 700 transplants, including 47 lung transplants and 23 heart transplants. Cleveland Clinic Abu Dhabi continues to perform complex, life-saving care in the UAE, giving patients the choice of world-class treatment in the region.

The patient’s medical journey began in 2004 in the U.S., where she was diagnosed with an atrial septal defect (ASD), a congenital heart problem. Over the years, the untreated ASD led to increasing pressure in her heart leading to pulmonary hypertension. After undergoing various treatment plans at multiple hospitals worldwide, the patient was referred to Cleveland Clinic Abu Dhabi in March 2022 in a critically deteriorated condition, with a weight loss of over 30 kilograms.

Explaining the patient’s condition, Dr. Fadi Hamed, consultant pulmonologist and medical director of lung transplant program 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.”

A comprehensive evaluation by the hospital's multidisciplinary teams determined that the patient required a complex surgical intervention, not just a lung transplant, due to the severe enlargement of her heart as a result of the ongoing pressure on the organ.

Dr. Mitesh V. Badiwala, Staff Physician in Cardiothoracic Surgery at the Heart, Vascular & Thoracic Institute, explains: "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 in 2004 had been treated earlier, she might not have suffered such severe deterioration.”

By February 2024, the patient’s condition stopped responding to medication. She suffered from excess water retention, continued high pressure, and severe breathing difficulties, with survival expected to be only a few months without intervention. The patient was immediately admitted to the ICU as preparations started for her transplant. 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 anesthesia was involved in the meticulous planning for the combined heart and lung transplant.

Dr. Usman Ahmad, Department Chair of Thoracic Surgery, who has previous experience with combined heart and lung transplants in the U.S., 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."

“Combined heart-lung transplant operations are uncommon even in large volume international transplant centers. Our program 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, 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.

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 utilize the latest technologies and innovations. Since the launch of the National Program for Donation and Transplantation of Human Organs and Tissues (HYATT) 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.”

The transplant was performed by a team of four cardiothoracic surgeons, two cardiothoracic anesthesiologists, five cardiothoracic specialized nurses, two perfusion experts and took over eight hours due to the complexity of her anatomy. The team led by Dr. Usman Ahmad and Dr. Mitesh 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 patient was monitored in the ICU and received comprehensive care, crucial to the success of this combined transplant. Her journey to restored health reaffirms Cleveland Clinic Abu Dhabi’s commitment to personalized, multidisciplinary care, utilizing cutting-edge technologies.

To learn more about Cleveland Clinic Abu Dhabi’s Heart, Vascular & Thoracic Institute visit, https://www.clevelandclinicabudhabi.ae/en/institutes-and-specialties/heart-vascular-and-thoracic-institute

For more information on Cleveland Clinic Abu Dhabi’s Transplant Center visit, https://www.clevelandclinicabudhabi.ae/en/institutes-and-specialties/transplant-center

To book an appointment at Cleveland Clinic Abu Dhabi, call 800 8 CCAD (2223) visit www.clevelandclinicabudhabi.ae or download the Cleveland Clinic Abu Dhabi Patient Portal App.