Lungs that live on after donor's death give hope to transplant patients

Pair of lungs that live on after donor's death give hope to transplant patients

• University of North Carolina found lungs kept alive by air for up to 4 hours
• Surgeons could now recover organs from people who die suddenly at home
• Experts predict the procedure could see thousands more transplants a year

Breakthrough: Though organ donors are still few, the new procedure could significantly boost transplant numbers

By MIA DE GRAAF, Daily Mail online

A pair of lungs that survive a donor's death have been hailed as a breakthrough for transplant patients.

Scientists found the organs can live for up to four hours after someone dies.

Unlike other organs, the air left inside keeps them from deteriorating.

In a groundbreaking $4million experiment, researchers at the University of North Carolina managed to recover lungs from people who died suddenly at home by pumping air into them within an hour of death.

Experts predict the procedure could see tens of thousands more transplants a year in America and the UK - and has paved the way for tests on other parts of the body.

Before, surgeons believed organs could not be retrieved from people who died unexpectedly.

As just two to three per cent of people die in circumstances appropriate for organ donation, lung transplants are rare and doctors often tell patients not to hold out hope.

But the new procedure could ease waiting lists which fail to save thousand each year.

In the on-going, three-year study, researchers used a pump to inject a small amount of air into the lungs of someone that died at home before transporting the body to hospital.

When it reached the theatre, the lungs were still 'breathing'.

'There aren't enough lungs. We're burying them,' said Dr. Thomas Egan of the University of North Carolina, Chapel Hill, who is leading the project. 'It turns out your lungs don't die when you do.

'There are huge logistical hurdles,' he said. 'But if we're right, this would have a profound impact on the number of lungs that are available for transplant.'

Lung cells don't depend on blood flow for oxygen, Dr Egan explained. When the heart stops beating, they use what oxygen is left in the air sacs and airways.

In a series of experiments with animals, Dr Egan showed lungs stay viable for an hour, or four hours if they are ventilated, before they're cooled to await transplant. 

Currently, only 15 per cent to 20 per cent of donated lungs are usable, often because complications during the donor's hospitalization damaged them.

Just 1,700 lungs transplants are performed each year, compared with nearly 11,000 kidney transplants from deceased donors.

Dr Egan, a cardiothoracic surgeon, said doctors don't even suggest the possibility of a lung transplant to thousands who might benefit because there aren't enough donors.

However, surgeons don't know if nontraditional organs work as well, cautioned Dr. Bryan Meyers of Washington University School of Medicine in St. Louis.

And critics warn even an hour is a limited amount of time to get hold of families to get consent for the procedure.

Dr Egan blasts ethical gripes with his project, claiming the ventilation process is merely an extension of CPR.

Typically, paramedics leave the breathing tube inserted in the person's throat. That makes it simple to restart ventilation to preserve the lungs, Egan said.

'If we can get the lungs ventilated within an hour, and then removed within an hour or two and cooled, we think they'll work just fine,' he said.

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Device May Increase Availability of Donor Livers for transplant

Investigational Device Prolongs Survival Of Livers for Transplantation

By Victoria Stern, General Surgery News

Patients who need a new liver to survive must hope that they are one of the approximately 13,000 liver transplant recipients in the United States and Europe each year. But with 30,000 people on waiting lists, and with only ice keeping livers for transplantation viable for up to 14 hours, the odds are not always in the patients’ favor. Each year, more than 2,000 livers don’t survive the journey to their new home.

A liver 30 seconds after connection to the OrganOx Metra device. Parts of the organ are still cold, while other parts are warm and perfused with red cell solution.

“Preserving organs by cooling them down is far from perfect,” said Peter J. Friend, MD, director of transplantation surgery, Nuffield Department of Surgical Sciences, Oxford Transplant Centre, U.K. “Although cooling the organ on ice slows its metabolism by a factor of 10, the liver continues to metabolize slowly and deteriorates as a result. It’s hard to tell which organs will work and which ones won’t.”

Now, however, Dr. Friend and his colleague Constantin Coussios, PhD, professor of biomedical engineering at the University of Oxford, have devised a novel technology that may be a game changer: A machine that allows the liver to function for up to 24 hours, as though it were still inside a human body.

On March 15, the team of engineers and physicians announced the preliminary success of this machine, which has safely transported livers to two transplant recipients at King’s College Hospital in London.

“The first two cases went very well,” said Dr. Friend. “They weren’t exceptionally high risk, but the machine did what it was supposed to do.”

The liver 5 minutes after connection to the OrganOx Metra, now fully perfused and at physiologic temperature.

Long Time in the Making

In 1994, Drs. Friend and Coussios devised the idea for the technology, but faced several engineering challenges while developing it. The co-inventors needed to create an artificial environment, that could simulate the key functions of the human body, including pumping blood and providing nutrition to the organ. These functions not only had to be automated to make it possible for transplant surgeons around the globe to use the technology, but also small enough for easy transportability.

After 15 years of developing and tweaking the design, Drs. Friend and Coussios have created a technology that appears to meet these requirements. The liver’s main blood vessels are connected to tubes on the machine, which automatically regulate the environment around the liver. The device maintains the liver at body temperature and infuses it with oxygenated red blood cells, nutrition such as glucose and amino acids, and other chemicals to create a physiologic environment that mimics the human body. The liver is not only kept alive, but it continues to produce bile as well.

Additionally, the machine is compact.

“It’s about the size of a supermarket trolley [shopping cart], which means it can go in back of ambulance, small plane or helicopter,” Dr. Friend said. “Size was very important because we knew there was no point in making a machine if it couldn’t fit in the back of a vehicle.”

Notably, the machine also may allow the liver to recover from injuries it sustained during or before removal, Dr. Friend pointed out. This function of the device is particularly important because it could expand the number of viable livers for transplantation. In recent years, the demand for livers has grown, as liver disease has become more common, whereas the quality of donor livers has diminished.

The King’s College Hospital, Oxford University and OrganOx team successfully connects the first human liver for transplantation to the OrganOx Metra device.

“More and more, donors tend to be older, and have a high body mass index or coexisting major health problems,” Dr. Friend noted. “Because of the increasing demand for livers, we are having to use organs we would have once said no to.”

Now with the machine, transplant surgeons can test how well the liver is working during preservation.

“If the liver works on the pump, then we can assume it will work in the recipient,” said Maria B. Majella Doyle, MD, MBA, associate professor of surgery at Washington University School of Medicine, St. Louis, who specializes in liver transplantation. Dr. Doyle was not involved in developing this pump, but she is performing research to develop a different liver pump system, one that also keeps the liver at physiologic temperature.

In April 2008, Drs. Friend and Coussios cofounded a company called OrganOx Ltd., to continue their University of Oxford research. With financial support from the Royal Society and several venture capital funds in the United Kingdom, the company has been working to bring the technology to patients.

Although promising, the device still needs more testing. The U.K. team has begun a pilot trial at King’s College Hospital to test the ability of the machine to transport livers to 20 transplant patients. If the trial is successful, OrganOx then could apply for marketing authority, which would make the device commercially available in Europe.

“If the machine is as good as we believe, we would expect a significant increase in patients who get liver transplants,” Dr. Friend said.

According to Dr. Doyle, the group is “ahead of the game.” To her knowledge, two other teams are developing physiologic-temperature liver pump systems—Dr. Doyle and her colleagues William Chapman, MD, and Vijay Subramanian, MD, at Washington University, and Constantino Fondevila, MD, PhD, at the University of Barcelona—but both are at more preliminary stages.

“The U.K. team is the first to produce human data with the pump and show it’s safe and viable as a liver transplantation device. Now, it’s important to make sure the technology is foolproof and cost-effective,” Dr. Doyle said.

“The U.K. team needs to be highly commended. The pump is a great achievement.”

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Kidney for transplant wasted after medical team was denied plane ride

The story speaks for itself. I need say anything more.

By Rey M. Nasol
Inquirer Southern Luzon

LEGAZPI CITY, Albay, Philippines -– A kidney ready for transplant was wasted on its way from Legazpi to Manila while another one is feared to have been rendered unviable after a pilot of the Cebu Pacific Airlines denied transport to a medical team from Legazpi City.

The team came from Cagayan De Oro City and passed by Cebu City on the way to Legazpi City before proceeding to Metro Manila.

Dr. Evy Sarmiento, Renal Disease Control Program (Redcop) coordinator at the Department of Health Bicol office, told the Philippine Daily Inquirer on Wednesday over the phone that the medical team got the first kidney from Cagayan de Oro City, boarded a Cebu Pacific plane to Cebu City, and then went to Legazpi City to fetch another kidney taken from a “brain dead” patient at the Sorsogon Doctor’s Hospital Monday.

The team, however, was denied transport from Legazpi to Manila by the pilot of the Cebu Pacific Air plane allegedly due to the improper packaging of the kidney obtained in Sorsogon.

“If they (Cebu Pacific Air) had allowed the transport from the south, why not the last part of their flight (from Legazpi to Manila)?” Sarmiento said.

She said the National Kidney Transplant Institute has been planning to sue the pilot, whose actions rendered the kidneys unviable.

The group reached Manila Tuesday morning, only to find out that the organs had been severely affected during the 10-hour land travel. The plane ride would have taken only 45 minutes.

“The institute occasionally harvests one to two kidneys in Bicol, which is being done at the Sorsogon Doctors’ Hospital but this was the first time our team was denied a plane ride for alleged improper packaging of the kidney,” Sarmiento said.

She explained that organs harvested should be hand-carried and should reach the recipient as soon as possible to avoid organ rejection by him.

“We have received a report, which we are still confirming, that the airline pilot, Captain Reuben Locson, offered to carry the organs through the cargo bay but the medical team insisted that these should be hand-carried so the group was denied conveyance,” Sarmiento added.

Cebu Pacific Air spokesperson Candice Iyog, in an interview over radio station dzMM, said the pilot refused conveyance because of the packaging for the kidney.

Iyog said the airlines was just protecting other passengers from possible infection or contamination.

But Sarmiento said the organ donors were healthy and that the kidneys did not pose any health hazard to passengers.

"How I wish the pilot valued the lives of the donors, as well as those of waiting recipients who spent months in the (donor-recipient) matching process through thorough tests and medications," she said.

“You Have the Power to Save Lives – Register to be an organ and tissue donor & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario at Trillium Gift of Life Network NEW for Ontario: recycleMe.org - Learn The Ins & Outs Of Organ And Tissue Donation. Register Today! For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

In Great Britain, register at NHS Organ Donor Register

In Australia, register at Australian Organ Donor Register

Your generosity can save or enhance the lives of up to fifty people with heart, kidneys, liver, lungs, pancreas and small intestine transplants (see allotransplantation). One tissue donor can help by donating skin, corneas, bone, tendon, ligaments and heart valves

Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Revolutionizing Organ and Tissue Donation and Transplantation

I am pleased to publish this guest post by Susan White.

Organ donation has helped save hundreds of thousands of lives; come to think of it, it’s a sort of irony when you consider that when one life is lost, many others could potentially be saved because their organs and tissue can be harvested and transplanted into the bodies of people who would otherwise die. The biggest problem with achieving success in organ donation is that it is very difficult to preserve the organ and keep it “alive” until it can be transplanted into the recipient’s body. Earlier, all organs were harvested from non-heart beating donors. But a few decades ago, it was found that donors who were brain-stem dead provided the best organs because they had oxygenated blood which protected them until they could be cooled.

Now however, another breakthrough in this discipline has ensured that more lives can be saved – scientists at the Sunderland University have been instrumental in pioneering a procedure that allows doctors to cool organs so that they can be preserved for patients waiting for a transplant. This procedure will hopefully reduce the large gap between the demand for and the supply of organs in the donor pool because it allows organs from non-heart beating (NHB) donors to be harvested and successfully transplanted into those who need them. Before the advent of this technique, it was almost impossible to find organs from NHB donors because they (the organs) which are starved of oxygen may be damaged and so, unsuitable for transplantation.

However, the research that is currently being undertaken at the Sunderland University shows that when organs from NHB donors are cooled rapidly, the damage is minimized and the organs are preserved in good condition, allowing them to be transplanted into patients with a reasonable chance of success. Based on this, new medical devices are being developed to cool the organs rapidly. They minimize damage to the tissue and help regenerate it until the organ can start working again and be transplanted into the recipient. Also, various teams are collaborating on finding the right anti-inflammatory drug to assist the cooling of the organ.

This finding will no doubt revolutionize organ donation and transplantation; with more donor organs being made viable for transplant, more lives can be saved.

By-line:

This article is contributed by Susan White, who regularly writes on the subject of surgical technician schools. She invites your questions, comments at her email address: susan.white33@gmail.com

“You Have the Power to Save Lives – Register to be an organ and tissue donor & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network. NEW for Ontario: recycleMe.org - Learn The Ins & Outs Of Organ And Tissue Donation. Register Today! For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

In Great Britain, register at NHS Organ Donor Register

In Australia, register at Australian Organ Donor Register

Your generosity can save up to eight lives with heart, kidneys, liver, lungs, pancreas and small intestine transplants (see allotransplantation). One tissue donor can help 75 to 100 other people by donating skin, corneas, bone, tendon, ligaments and heart valves

Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Liquid keeps transplant organs viable 10 times longer

This research is certainly good news for organ transplantation. Because there are more patients waiting for life-saving transplants than the supply of available organs this new preservation solution has the potential to save many more lives.

Acceptable preservation times vary with the organ. Presently, the time between organ recovery from the donor and transplant recipient is very short and limits the distance that can be traveled to recover donor organs.

Most surgeons prefer to transplant the heart within 5 hours of its removal; the kidney can safely be stored for 40-50 hours, but earlier transplantation is preferred. Most pancreas transplants are performed after 5-15 hours of preservation. Liver transplantations usually are performed within 6-12 hours. The maximal safe interval for the lung to remain ischemic has not been defined. Based on empiric observation, 6 hours is the selected limit (Although laboratory data and isolated clinical reports suggest that good results may be expected with storage times of 8 hours or longer with the use of the newer preservation solutions, increased ischemic time remains a strong and important independent risk factor for poor recipient outcome.)

By Lesley Ciarula Taylor Healthzone.ca

A pig’s heart that started beating again 10 days after it was put in a jar of chemicals could revolutionize organ transplants and rescue thousands who die waiting, a Harvard scientist says.

“We were amazed,” Dr. Hemant Thatte told the Star on Tuesday. “We didn’t expect it to start after 24 hours. When the heart started beating . . . it still gives me goose bumps.”

Thatte, an assistant professor of cardiothoracic surgery at Harvard, and his team soaked the heart in Somah, a mixture of 21 chemicals they have developed to prolong the time organs can spend between removal and transplant.

The limit now is between four and 24 hours, depending on the organ. And hearts are among the trickiest transplants.

“I think this has tremendous potential to help people. I just want to see it succeed with the proper scientific scrutiny,” said Thatte. “It has the potential to cause a paradigm shift in the way transplant surgery is performed.”

Somah, which is Sanskrit for “elixir of immortality,” blends chemicals already approved by the U.S. Federal Drug Administration or, in some cases, already commonly available. In the mix is citrulline malate, currently sold as a performance-enhancing dietary supplement for athletes and based on watermelon rind.

The solution not only preserved organs taken from live pigs, but also kept organs working that came from cadavers, said Thatte.

Ontario is one of four Canadian provinces that allows organ donations after cardiac death. The other provinces and the United States allows donations only after brain death.

So far this year, 323 people in Ontario have received transplants; another 1,615 are on waiting lists, according to the Trillium Gift of Life Network. Organ donations rose by more than 25 per cent in Canada from 1999 to 2008, according to the Canadian Institute for Health Information — but still fell short of demand.

In 2008, about 215 Canadians died while waiting for an organ transplant, CIHI statistics said.

“We don’t have enough donors and organs,” said Thatte. “A major, major point of Somah is that it is able to revive hearts from cadavers. We believe this could be a major source of donated organs.”

Despite his enthusiasm for Somah’s potential, Thatte is aware of its controversy.

In series of articles a few years ago, the prestigious New England Journal of Medicine questioned whether heart transplants after cardiac death are unethical. Because the donated heart is restarted in another body, it raises the question of whether it could have been restarted in the original body.

“We try to do our best in terms of science and then let nature take its course,” said Thatte of the ethical debate.

Thatte’s laboratory, part of the V.A. Boston Health Care System, has worked on transplant research for 10 years. An earlier discovery pioneered Gala, a solution that preserves blood vessels and formed the basis for Somah.

Thatte reported on his work in an article in the journal Circulation late last year.

“It involves a lot of staring at metabolic charts,” said Thatte of his work. Those charts, laced with multi-photon imaging, revealed Somah hearts functioned with minimal decay and damage, particularly compared with the existing organ solution, Celsior.

Transport organs are vulnerable to damage from many sources, including too much oxygen and the creation of ammonia. Somah, said Thatte, counteracted both of these.

The next stage of research would be transplanting the Somah-preserved hearts back into pigs. If that works, human trials would start, said Thatte.

A group of Harvard Business School students excited by the discovery have created a business plan for Somah and created a start-up, called Hibergenica, to raise funding to continue the research.

“You Have the Power to Save Lives – Register to be an organ and tissue donor & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network. NEW for Ontario: recycleMe.org - Learn The Ins & Outs Of Organ And Tissue Donation. Register Today! For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

In Great Britain, register at NHS Organ Donor Register

In Australia, register at Australian Organ Donor Register

Your generosity can save up to eight lives with heart, kidneys, liver, lungs, pancreas and small intestine transplants (see allotransplantation). One tissue donor can help 75 to 100 other people by donating skin, corneas, bone, tendon, ligaments and heart valves

Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Invention Circulates Interest Among Diabetics, Organ Transplant Patients

I'm always pleased to report on research that has potential for improving the organ transplant process and the "wonder-cloth" described here may be a breakthrough. Organs must be preserved and transported as quickly as possible to the recipient within hours of being removed from the donor and this may have some future benefit.

Fiber ‘Wrap’ Preserves Tissue and Encourages Blood Vessels to Open

University of Texas at Dallas

Scientists at The University of Texas at Dallas have filed a patent disclosure on a medical device that looks like a blue elastic bandage and acts like a wonder-cloth that helps preserve transplant organs, improve circulation and heal wounds.

Chemistry Professor Kenneth Balkus and Ph.D. student Harvey Liu say Liu’s early work on self-healing smart films led to the new, blue bandage that releases a controlled, steady dose of nitric oxide.

Nitric oxide (NO) is known to open blood vessels and keep them relaxed and flexible—key factors in keeping transplant organs viable and offering hope to diabetic patients who suffer from low blood flow in their extremities, especially the feet.

The development earned Liu a finalist position in the Collegiate Inventors competition, where he competed against other science, mathematics, engineering and technology inventors from universities including Johns Hopkins, Harvard, the University of California at Berkeley and the Massachusetts Institute of Technology.

“This research – and working in the Balkus group at UT Dallas, for that matter – has been an exciting journey,” Liu said.

“We started with nothing but an idea, one that evolved into a tangible product that we could potentially use to help people address ailments ranging from diabetes to hair growth to the preservation of transplant organs,” Liu said. “I’ve found the journey so rewarding.”

Balkus said the bandage’s blue color comes from synthetic zeolite nanoparticles throughout the material.

“The composite papers were fabricated by electrospinning biodegradable polymer fibers that contain zeolites or diazeniumdiolates,” Balkus said. “Upon exposure to moisture, the polymer fibers degrade and the NO is released.”

Wound dressings have evolved dramatically from strips of cloth ripped by hand into antiseptic marvels of modern medicine. Liu said he expects clothing or material to be another way for the zeolite cloth to help people.

“We’re interested in evaluating how well textiles—socks—or wraps made from this material can promote blood flow in the feet of patients with diabetes,” Liu said.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives with heart, kidneys, liver, lungs, pancreas and small intestine transplants. One tissue donor can help up to 100 other people by donating skin, corneas, bone, tendon, ligaments and heart valves