Lexington, Kentucky (April 14, 2025) -As a pathologist, MARIA BRAMAN, MD, is trained to see the body as a collection of parts, interconnected and working in perfect concerts to form the quiet symphony of life. The heart pumps blood oxygenated by the lungs to every corner of the body through miles of containers, supplying its organs and nutrients with air and nutrients to fuel its lifespan.
But for her training as a doctor, Braman knows too much how mold spores disrupt the delicate balance of the body, even with minimal transmission, for example. She spent her career identifying these confusions in others.
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Braman's medical career took her across the country, from her hometown of Washington, DC to Montana and Kentucky. Before being appointed vice president of medical affairs for her hospital, she and her family, who had worked in her Montana days to help establish the state's first certified breast center, embraced a lively and adventurous lifestyle. The weekend was spent hiking and running 50k races over the heavy-duty terrain of Montana. After a busy, busy life in DC, Braman tasted the clean air of the big sky country.
She later discovered that, after all, the air wasn't that clean.
Braman's house was adjacent to a large ranch with hay stretches. Prosperity in hay les was a type of mold that can lead to serious lung disease when inhaled by patients with specific susceptibility.
Hypersensitivity pneumonia is considered a relatively rare interstitial lung disease in the United States, affecting approximately three in 100,000 people. Prevalence tends to be higher in rural and agricultural areas where organic dust exposure is more common.
“My family and I enjoyed being outdoors in the wilderness and we opened our windows at home,” Braman said. “That's ironic. I think you're moving to Montana, where you're much healthier than living in the city. You should have stayed in smoke and traffic.”
Braman was diagnosed with hypersensitivity pneumonia in 2013. Her health slowly declined over the years. First, she realized she couldn't run anymore, but she was still able to hike. However, the slope was too high and hiking became a challenge. Determined to stay active, she walked the loop on flat ground. Over time, that became difficult too. In 2016, she came to Kentucky and was hired to join the leadership team Appalachian Regional Health Care, Before he was first appointed as Vice President of Medical Care, Chief Medical Officer. As she swapped the big skies in Montana for Kentucky, she managed lung health with British healthcare pulmonary surgeon Erin Kamack and made medication and lifestyle modifications.
Despite her poor lung function, Braman decided to remain strong for her family. When the gradually loss of ability and independence began to affect her mental health, she enrolled in treatment to improve her thinking and outlook.
“I don't call myself a religion, but I have a strong faith,” she said. “I really tried to make sure I wasn't overwhelmed by it. You have to move forward, do you know?
Slowly decreases, sudden decreases
That strong mindset helped her until March 2024 when she was diagnosed with pneumococcal pneumonia (PJP). People with healthy lungs may be exposed to fungal spores and show no symptoms, but it can easily spread and be particularly harmful to those with compromised lung function. Braman was hospitalized for five days. Her lungs, already irreparably damaged by pneumonia, could no longer breathe for her.
“Pneumonia can be a major regression for patients with hypersensitivity pneumonia,” he said. Naureen Narula, MD. , Assistant Professor of Surgery and Respiratory Specialist UK Healthcare Transplant Centres. “Inflammation from pneumonia can stress already damaged lung tissue and cause acute deterioration – essentially, a sudden worsening of pulmonary fibrosis. This inflammatory cascade can promote scarring, reduce oxygen exchange, and lead to a rapid decline in lung function.”
After she was discharged from the hospital, even small things like doing laundry, walking around the grocery store, or taking a shower felt impossible. PJP damage exacerbated the effects of chronic lung disease over a decade. With wheelchairs and oxygen reliance on Braman, it's time to consider getting a double lung transplant assessment.
“In my opinion, 'Okay, I have pneumonia. I have pneumonia, I know a lot of people who have had pneumonia and have been treated, and they're going back to where they were,” she said. “It shocked me when Dr. Kamac came to my hospital room and said it was time to start discussing the transplant, and I wasn't thinking that way at that point.
But it was her training as a doctor that reinforced the reality of her situation.
“There's nothing naive about how bad you're getting, and that was clear to me,” she said. “You're not naive about how serious it is. You can't get away with it.”
With the support of Narula and port coordinator Ashley Rakitjan, Braman has begun an intensive, multi-month assessment process. Finally, on November 8th, she was placed on the list of double lung transplants, preparing herself and her family for the pain of long waiting times.
After all, they don't have to wait long.
Six days later
Less than a week after being listed, due to a routine visit with Narula at a UK Transplant Centre Clinic, Ashley informed her that Narula would not be able to see her that day.
It wasn't a problem, Braman thought. As a doctor, she knows how often they are called due to emergencies.
Ashley kneels beside Braman's wheelchair. “Don't you want to know why she won't see you today?” she asked. Braman shrugged.
“She said, “We have lungs for you, Dr. Narra went to see them, and we have to admit you now,” Braman said. “It's crazy. I went in for an appointment. Then I was shot in the operating room in the car. It was incredible. It felt miraculous.”
“It was truly one of those rare and beautiful moments with you,” Narula said. “These decisions take time — discussions with the donor team, reviews of the imaging and labs, confirmation of cross-matches. By 7:30am, coincidentally, Maria had arrived for her everyday clinic. She arrived just 30 minutes later. The team reminds us of these moments.
Braman desperately called out her family. Her mom flew from Washington, DC, and the family gathered in the hospital and settled down for a lengthy operation. Many patients on the waiting list have to contest the possibility that they will be sent home if their organs may not fit perfectly, but the stars were tailored to Braman. The implantation performed by Matthias Loebe, MD took several hours.
When she woke up, her breathing tube was removed and she carefully took some short breaths. After living with her damaged lungs and relying on oxygen for a long time, Braman almost forgot what breathing was like.
“It's something you really have to train your mind,” she said. “I didn't understand it until I had to hear people talk about it and go through it. It's one of the things you keep listening to from lung transplant patients – learning how to breathe again, trusting new lungs – and it's scary. I still have to remind myself. It gets better, but it's not entirely natural yet.
“You're responsible for someone else.”
Part of knowing her new lungs is accepting the gifts her donors have given and the sacrifices from their grieving families. Braman knows nothing about her donor. Her decision to become an organ donor will allow Braman to spend more time with her family. The night before her surgery she didn't sleep. While her family was celebrating, Braman was heartbroken for the grieving family of her donors. She described this feeling as something similar to survivor's guilt. She knows that she is not the reason why a person lost her life, but it is that loss that allows her to live. She returned to the same strong mindset that helped her throughout the darkest days of lung disease.
“Someone made this incredible choice to donate. Their hope is not that you live in despair and feel guilty about it,” she said. “The hope for donation is that you are giving someone else a chance to live perfectly.”
Almost five months after the transplant, Maria feels stronger than she's had for years. She walks two miles a day. She enjoys her ability to do everyday things, including walking around the grocery store. She thinks about the future differently. Previously, she had planned to prepare her children and how to provide them when she died. Now she has a different kind of plan. It's about visiting my Costa Rican brothers and taking a holiday in Italy. Although Braman is not yet allowed to fly by plane, she is counting down the days when she can live her life in full, knowing what she wants for her.
“Not only are you and your family, but now you're not just someone else, you're responsible,” Braman said. “I'm talking a bit with my lungs. I know we're still getting to know each other, and we're trying to make sure they're taking good care of us.”
Even after reading her extensive medical training, years of medical practice, subsequent months of organ transplantation, testimony from other recipients, and long conversations with the transplant team, Braman still holds a tribute to the complexity of the human body, delicate adjustments of the organ system, and the delicate adjustments of science that become complicated as an organ transplant. She feels it is impossible to clarify. You need to experience it yourself.
“I don't know how to explain that,” she said. “It's amazing how someone else's lungs keep me alive. I'm a doctor. I should be able to grasp this. But there's such an emotional part that goes beyond logic and medicine.”
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April is Donation Life Month, a time dedicated to raising awareness about the power and importance of donating organs, eyes and tissues. Please see details about organ donation. Please register to be an organ donor.
