Norway's Crown Princess Mette-Marit Successfully Receives a New Lung

Diagnosis and Course of Illness

Mette-Marit was diagnosed with pulmonary fibrosis in 2018, a chronic condition that leads to scarring in the lungs and results in reduced oxygen uptake. Initially, the wife of Crown Prince Haakon (52), heir to the Norwegian throne, was able to continue living relatively normally after the diagnosis. However, in the six months prior to the surgery, her condition had increasingly worsened, and the court recently referred suddenly to a "life-threatening" condition of the Crown Princess.

Waiting for a Suitable Organ

The quick appointment came as a surprise, it was said. Aleksander Sekowski, head of information at the Norwegian court, commented in the newspaper Aftenposten: "Normalerweise ist das nicht so." According to the Norwegian news agency NTB, only ten people in Norway were on the waiting list for a new lung last week. On average, it was said, one cannot say how long patients wait for an organ — in extreme cases, a transplant may be possible within hours, but it can also take several weeks.

Julia Melchior, an expert on organ donation, explained the urgency in conversation with the newspaper: "Es ist relativ dramatisch." She pointed out that the size of the lung is crucial: "Ist die Lunge zu klein, legt sie sich nicht gut an die Thoraxwand an. Dann kann sie sich nicht gut entfalten, wird nicht so gut belüftet und man bekommt sehr leicht eine Lungenentzündung." Melchior added that it was "fantastisch, dass sie eine Lunge gefunden haben, die so gut passt".

The Surgical Procedure

The renowned heart and lung surgeon Arnt Eltvedt Fiane (68), professor and head of thoracic surgery, performed the highly complex procedure, which typically takes three to five hours. Speaking to the Norwegian newspaper Verdens Gang, Fiane described the dramatic procedure in the operating room: "Wir müssen den Brustkorb öffnen und eine Herz-Lungen-Maschine anschließen, wie bei Operationen am offenen Herzen." The diseased lungs would be removed, which according to Fiane can be the most difficult part of the entire procedure. Once the diseased organ is removed, the new lung lobes are inserted step by step.

Christoph Hörmann, an intensive care physician, explained how the procedure works: "Ziel der Lungentransplantation ist, dass der Gasaustausch wieder normal funktioniert." Size match and blood type must be correct, otherwise complications may arise. In extreme cases, a donor lung may become available within a few hours — for example, if a patient is classified as "high urgent" and moved up the waiting list. In acute life-threatening situations, such a classification is possible. Hörmann also pointed to a risk: "Patientinnen und Patienten können vor der Transplantation in der erkrankten Lunge einen hochresistenten Keim haben. Trotz aller Vorsichtsmaßnahmen besteht die Gefahr, dass der sich dann in der neuen Lunge einnistet. Das ist manchmal kein Problem, kann natürlich aber auch Komplikationen zur Folge haben."

Long-Term Risks and Prognosis

Lung specialist and chief physician Are Holm (60) gave a sober assessment of the procedure. While the surgery is initially a blessing, it does not yet mean a definitive all-clear. "Wie alle anderen frisch transplantierten Patienten wird auch die Kronprinzessin für einige Wochen im Krankenhaus bleiben", Holm said according to the royal house's statement. "In dieser Zeit könnten Medikamente angepasst, eventuelle Komplikationen behandelt und die Rehabilitation eingeleitet werden." The court also expressed relief: "Wir freuen uns sehr, dass bisher alles gut verlaufen ist."

The sympathy from home and abroad has been great, the Norwegian court said. "Die Anteilnahme bedeutet viel in ihrer schwierigen Situation", it was communicated. Norwegian lung specialist Olav Kåre Ref had already pointed out the long-term consequences to NTB at the beginning of June: "Man muss vorsichtig sein und gegen mögliche Abstoßungsreaktionen sowie Infektionen kämpfen, die jederzeit auftreten können." The Crown Princess will need to take medication for life. Hörmann added: "Je weniger Abstoßungsreaktion passiert, desto besser, denn bei jeder Abstoßung kann Funktionalität des transplantierten Organs verloren gehen."

According to the hospital, 85 to 90 percent of patients with a new lung survive the first year after transplantation. After five years, 70 to 75 percent are still alive, and after ten years, only about half of the patients. With the transplant, Mette-Marit's chances are now better, although a residual risk remains.

The Family at Mette-Marit's Side

Crown Prince Haakon (52) will adjust his schedule to support his wife, the royal house said. The heir to the throne had repeatedly canceled appointments in recent months to be with Mette-Marit. The couple's daughter, Ingrid Alexandra (22), had also returned home from her studies in Australia to be with her mother. According to a court, the Crown Princess's eldest son, Marius Borg Høiby (29), had raped two women under Norwegian law and abused two ex-girlfriends in the relationship, and had repeatedly tried unsuccessfully to be released from pretrial detention citing his mother's health condition. After the successful transplant, the Crown Prince's family can likely look to the future with somewhat more confidence — even though, as the court emphasized, further steps are necessary.

Organ Donation as an Act of Solidarity

Organ donation is "ein wirklich wichtiger Akt der Solidarität", emphasized Pia Kruckenhauser. Donor organs are also scarce in Austria: in 2018, there were 22.6 donations per million inhabitants, and 795 patients received an organ. In 2023, there were only 17.6 donations per million, which meant 648 transplants. There are several reasons for this, one being certainly a lingering consequence of the Covid-19 pandemic, during which fewer donor organs were available.