Two major advances in respiratory medicine are transforming care for vulnerable populations: pediatric hospitals are deploying minimally invasive lung procedures at unprecedented speed, and HIV-positive patients are gaining access to life-saving lung transplants previously unavailable to them. These developments represent significant progress in expanding treatment options for children with complex airway conditions and adults living with HIV who need organ transplants.

How Are Pediatric Hospitals Bringing Advanced Lung Procedures to Children?

Rady Children's Health in Orange County has accomplished what seemed impossible just months ago. In record time, the hospital developed a comprehensive advanced bronchoscopy program, launching it fully operational this April, more than a year ahead of schedule. The program is now one of only a handful of pediatric healthcare systems nationwide offering these specialized services.

Advanced bronchoscopy, also called interventional pulmonology, allows pulmonologists to look inside a child's lungs and airways using a thin, flexible camera and specialized tools without requiring open surgery. These minimally invasive techniques enable safer, faster diagnosis and treatment of many airway and lung conditions that previously required invasive surgical procedures.

"We had laid out a two-year plan but now have gone 100% live with all our services," said Dr. AJ Katz, who was recruited from Children's Hospital of Philadelphia to develop the program.

Dr. AJ Katz, Pulmonologist at Rady Children's Health

Dr. Katz's team, working closely with pediatric anesthesia, critical care, otolaryngology, gastroenterology, radiology, and surgery specialists, provides leading-edge care for a wide range of conditions. The program offers several advanced diagnostic and therapeutic techniques:

• Diagnostic Tools: Endobronchial ultrasound and CT-guided biopsies to identify lung abnormalities and tumors
• Therapeutic Treatments: Cryotherapy, endobronchial valves, electrocautery, and argon plasma coagulation to treat airway conditions
• Specialized Procedures: Balloon dilation, whole lung lavage, and endoscopic treatment of tumors, foreign bodies, fistulas, and air leaks

One recent case illustrates the program's impact. An infant with a tracheoesophageal fistula, an abnormal connection between the windpipe and esophagus that allows food and stomach acid to enter the lungs, was treated through the airway in a minimally invasive way rather than requiring neck surgery. The infant spent only a few days in the hospital, compared to the longer recovery typical of traditional surgical repair.

The conditions the program treats include pulmonary nodules, thoracic lymphadenopathy, mediastinal masses, lung and endobronchial tumors, interstitial lung disease, plastic bronchitis, persistent air leaks, tracheoesophageal fistulas, and airway obstruction or stenosis. Dr. Katz estimates his team will care for well over 100 patients at Rady Children's Health within the first year of going live.

What Changed for HIV-Positive Patients Needing Lung Transplants?

In a historic first, NYU Langone Health performed the world's first HIV-positive-to-HIV-positive lung transplant on March 21, 2026. This breakthrough opens a pool of potential donors who were previously ineligible, significantly expanding transplant options for people living with HIV who need new lungs.

The surgery was made possible by a research protocol sanctioned by the U.S. Food and Drug Administration under the 2013 HIV Organ Policy Equity Act, commonly known as the HOPE Act. While HOPE heart and abdominal organ transplants have been performed before, this marks the first time the protocol has been successfully applied to lung transplantation.

"This is a watershed moment for the HIV-positive community and represents real progress in creating equity in organ transplantation," said Dr. Sapna Mehta, clinical director of NYU Langone Transplant Institute.

Dr. Sapna Mehta, Clinical Director of NYU Langone Transplant Institute

The patient, Bertrand Nelson, 56, had lived with HIV for nearly 26 years. In 2000, he was diagnosed with both HIV and sarcoidosis, a disease that can affect the lungs and liver. After contracting Legionnaires' disease in 2021, which caused severe pneumonia and reactivated his sarcoidosis, his lung function declined significantly. By 2024, he required increasing amounts of oxygen to breathe and was referred to NYU Langone for evaluation for both lung and liver transplants.

Nelson received both a new lung and a new liver on the same day. The lung transplant was performed by Dr. Stephanie H. Chang, surgical director of lung transplantation at NYU Langone, while the liver transplant was performed by Dr. Karim J. Halazun, surgical director of liver transplantation. The outcome has been remarkable: Nelson is now off oxygen for the first time in four years.

Approximately 1.2 million people in the United States are living with HIV. Thanks to advances in antiretroviral therapies, or ART, most people with HIV can live long, healthy lives. Most people using ART are unable to transmit the virus and have near-normal life expectancies. However, some HIV-positive individuals develop serious lung conditions that require transplantation, and the HOPE Act research protocol now makes that lifesaving option available to them.

Why Do These Advances Matter for Respiratory Health?

Both developments address critical gaps in respiratory care. For children, advanced bronchoscopy eliminates the need for open surgery in many cases, reducing recovery time, hospital stays, and surgical risks. For HIV-positive adults, the HOPE Act lung transplant protocol removes a barrier that previously excluded them from a life-saving treatment option.

Dr. Katz emphasized the importance of bringing adult-level interventional pulmonology techniques to pediatric care. "Pediatrics in this specialty has been trying to catch up to adult medicine, and I wanted to bring the adult world down to pediatrics by offering minimally invasive procedures to children who weren't being offered them," he explained.

Dr. Katz

The success of these programs also highlights the importance of institutional commitment and interdisciplinary collaboration. At Rady Children's Health, the rapid development of the bronchoscopy program required buy-in from leadership and specialists across multiple departments, enabling the hospital to compress a two-year timeline into nine months.

As these innovations continue to expand, they offer hope to patients and families facing complex respiratory conditions. Nelson's message to others in the HIV community reflects this optimism: "There are so many others who need access to this level of care, and the more organs that become available, the better the odds of finding the right match and living a long life".