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Norway’s Crown Princess Mette-Marit will likely need a lung transplant as her health has worsened in recent months, the country’s royal household has said.

The princess, 52, was diagnosed with pulmonary fibrosis in 2018. The degenerative disease creates scar tissue that stiffens the lungs making it difficult to breathe and for oxygen to enter the bloodstream.

Tests in autumn showed “a clear worsening” of her health, the palace said on Friday. “We are reaching the point where a lung transplant will be necessary,” Are Martin Holm, head of respiratory medicine at Oslo University Hospital, said.

Princess Mette-Marit told public broadcaster NRK that her illness had developed “faster than I’d hoped”.

No decision has been taken yet on whether she will be placed on the transplant waiting list, Dr Holm said. The palace said her doctors had started the process towards an evaluation for lung transplant surgery.

In Norway, there are usually between 20 and 40 patients on the waiting list for a lung transplant and Princess Mette-Marit will not be given preferential treatment if she is placed on the list, local media reports.

Although she is not yet on a donor list, Dr Holm said her heathcare team was “undertaking the necessary preparations to ensure that [a transplant] will be possible when the time comes”.

The palace said Princess Mette-Marit had “an increasing need” for rest and a targeted exercise regimen.

However, she had “expressed a strong interest in continuing to carry out her duties”, it added in a statement on Friday. Her royal duties and engagements will adapted to her ongoing health issues.

Dr Holm described pulmonary fibrosis to reporters as a “dangerous disease” that often could not be seen because it depended on how sick an individual was.

At rest, they might be able to breathe normally, he explained, but when they exert themselves – through exercise, for example – their lungs “can no longer keep up”.

Princess Mette-Marit’s husband, Prince Haakon, Norway’s future king, sat beside her for an interview with NRK, in which he explained that she may appear “perfectly fine” when sitting still, but said he had noticed her struggling more with breathing.

He also said she had less energy and was getting ill more often.

Hiking or skiing together – activities the pair enjoy – were no longer possible, the crown prince added.

The thought of the transplant alone had been demanding, Mette-Marit said, as she knew it will involve risks.

A successful transplant hinges on several factors, including finding the right match and ensuring the body does not reject the new organ.

Transplant is seen as a last resort, Dr Holm explained, telling reporters that individuals must be significantly ill and have a limited life expectancy before a lung transplant can be deemed appropriate.

News of the princess’ deteriorating health comes months after her eldest son was charged with 32 offences, including four counts of rape.

Marius Borg Høiby, 28, denies the most serious accusations against him, but plans to plead guilty to some lesser charges when the trial begins, his lawyer Petar Sekulic told news agency Reuters in August.

Mr Høiby is the stepson of the heir to the Norwegian throne, but does not have any royal title or official duties.

Parents of children with thalassemia in India say they are devastated after life-saving blood transfusions left their children HIV-positive, confronting them with illness, social stigma, and uncertainty.

Thalassemia is a genetic blood disorder that requires regular transfusions to manage severe anaemia and sustain life.

On Wednesday, authorities in central state of Madhya Pradesh said five children with thalassemia, aged three to 15, have tested positive for HIV, prompting concerns over blood transfusion practices. A committee has been set up to investigate the cases.

The families are from Satna district. Although the infections were detected during routine screening between January and May 2025, they drew wider attention after local media reports earlier this week.

The cases follow a similar incident in the eastern state of Jharkhand weeks earlier, where five children with thalassemia, all under eight, were found to have contracted HIV after blood transfusions at a state-run hospital.

HIV, or human immunodeficiency virus, spreads through unprotected sex, unsafe medical practices, infected blood transfusions, or from mother to child during pregnancy, childbirth or breastfeeding.

While no longer a death sentence, it requires lifelong management. In India, more than 2.5 million people live with HIV, with about 66,400 new infections each year. Over 1.6 million are on lifelong treatment at antiretroviral therapy (ART) centres, government data shows.

Satna district collector Satish Kumar S said the five children had received blood transfusions at different locations, involving multiple donors.

Health officials said these included government hospitals and private clinics, and that all the children are now receiving treatment.

In one case, officials said both parents of a three-year-old were HIV positive. In the other cases, the parents tested negative, ruling out mother-to-child transmission.

Satna’s chief medical and health officer Manoj Shukla said children with multiple transfusions are considered high-risk and are routinely screened for HIV.

“Once detected, treatment was started immediately and is continuing. At present, the children are stable,” he said.

Every unit of blood issued by the district hospital’s blood bank is tested according to government protocol and released only after a negative report, Dr Shukla says.

However, in rare cases, blood donors who are in the early stages of HIV infection may go undetected during initial screenings but test positive later, he adds.

Cases of thalassemia patients contracting HIV during treatment are not new in India.

In October, after similar incidents in Jharkhand, authorities suspended a lab assistant, the doctor in charge of the HIV unit and the chief surgeon of the state-run hospital involved.

Chief Minister Hemant Soren also announced an assistance of 200,000 rupees ($2,212; £1,655) for each affected family.

In 2011, authorities in Gujarat launched an investigation after 23 children with thalassemia tested positive for HIV following regular blood transfusions at a public hospital.

Last week, thalassemia patients urged India’s parliament to pass the National Blood Transfusion Bill 2025, saying it would strengthen regulation of blood collection, testing and transfusion.

Campaigners, including patients who contracted HIV through unsafe transfusions, called the bill a long-awaited step towards safer, quality-assured blood for those reliant on frequent transfusions.

In India, where healthcare access can be limited, especially in rural areas and small towns, families of the HIV-infected children in Madhya Pradesh and Jharkhand are deeply concerned.

“My daughter was already suffering from thalassemia. Now she has got HIV, all thanks to the pathetic medical facilities of Madhya Pradesh,” said one father, whose child is among those affected.

Another parent said their child was struggling with side-effects of HIV medication, including vomiting and constant fatigue.

In India, HIV still carries strong social stigma, often leading to discrimination. In Jharkhand, the family of a seven-year-old boy was forced to leave their rented home after the landlord learned of the child’s HIV status, the father told the BBC.

“I tried to convince them a lot, but they remained adamant on getting the house vacated. So, I had to return to my village, about 27km [17 miles] away,” said the father, who is a farmer.

“In the village, it is not only a challenge for my son to get better health facilities, but he is also deprived of a good education.”

Additional reporting by Mohammad Sartaj Alam in Jharkhand

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