Double lung transplant gives Willmar, Minn., native 'a second chance at life'

When I read Pam Lehn's story it was as if she was talking about my lung transplant at Toronto General Hospital. 

Like her, I suffered from Idiopathic Pulmonary Fibrosis (IPF) and experienced the same symptoms and transplant process. She kept a wonderful blog hungry-for-air.org during her diagnosis and treatment that I encourage you to read.

Pam Lehn, is a Minnesota  native now living in Toronto .

By Anita Polta,, West Central Tribune

WILLMAR -- Pam Lehn and Scott Dyer talked it over and decided that when the time came, it would be Dyer who broke the news.

On Feb. 3, Dyer blogged the words they waited months to write:

This morning at 1 a.m., the nurse awakened Pam with the news we have been waiting for: a set of donor lungs was available for transplant.

A long surgery and recovery lay ahead but it was the couple's best -- and only -- hope for keeping Lehn alive.

Four months later, they're still awed at how much has changed since Lehn, 56, received the double lung transplant at Toronto General Hospital in Toronto, Ontario.

"Just standing and doing the dishes, it's like 'wow,'" Lehn said. "It gives you a second chance at life. Really, it gave me my life back."

Said Dyer: "Since the transplant, every day is better than the one before. It's truly remarkable."

One of Lehn's goals during a mid-May trip to Willmar, where she grew up and where some of her family, including her 91-year-old father, Lloyd Lehn, still live: walking the path down to the lakeshore at the couple's vacation home on Games Lake.

"I have this wonderful place to look forward to when I can breathe again and enjoy all the riches," she wrote last September on her blog, Hungry for Air, that chronicles her months-long fight with pulmonary fibrosis (hungry-for-air.org).

The first hint of the struggle ahead surfaced in the summer of 2008 when Lehn and Dyer traveled to Tibet while visiting China during the Summer Olympics. Everyone in the group felt the effects of the altitude "but Pam could never catch her breath," Dyer recalled. "She was red-faced and blue-lipped and laboring all the time. That's when we started to think something was wrong."

Back home in Toronto, where they have lived for several years and work in film animation, Lehn's lung capacity continued to worsen.

Fall 2008:

I was having difficulty moving around with heavy coats and boots. Dressing to take the dogs out, I had shortness of breath. Every day when I went to work I had to climb a spiral staircase, every morning I was at my desk catching my breath.

One year, several imaging tests and a lung biopsy later, Lehn and Dyer got the news. Lehn had idiopathic pulmonary fibrosis, a form of lung disease leading to progressive scarring of the lungs and progressive deterioration in the ability to breathe.

About 128,000 new cases of IPF are diagnosed annually in the United States. The cause of the disease is unknown.

Lehn and Dyer turned to the Internet for information, and what they found was bleak: There is no cure for IPF and few effective treatments, other than a lung transplant.

"That's when we realized just how truly serious this was," Dyer said.

There was one piece of good news: Toronto General Hospital had an organ transplant program with a worldwide reputation for success -- and it was close to home besides.

Sept. 8, 2012:

I was slowly starting to lose steam over the summer and by mid-August my family showed concern that I was having a much more difficult time doing the simpler things like standing, cooking, walking from room to room, even brushing my teeth ...

I called my doctor this Tuesday to say I couldn't walk without being short of breath. They swung into action, had me go in for tests, agreed that the disease had further advanced from July and we completed the forms and as of Friday, September 7th, 2012, I am listed for a lung transplant.

By winter her condition was deteriorating alarmingly. She couldn't walk without oxygen. Her day narrowed to one task at a time: Get dressed, then rest; brush her teeth, rest again.

"As Pam got more ill, literally the only thing she focused on was staying alive," Dyer said. "By the final week in January, it was so severe and her oxygen needs were so high, I realized we could no longer take care of her at home."

Patients can wait anywhere from six months to two years until a donor match is found. As many as 20 percent die before a matching lung or pair of lungs becomes available for transplant. Lehn was so sick that she was placed at the top of the waiting list. She ended up waiting five months to receive new lungs.

Feb. 5, 2013

As I write this, Pam has been out of surgery for a mere 48 hours. Yet she is sitting on a chair in front of me. There is no ventilator. She is breathing on her own. Tomorrow she will walk.

Through the fall and winter, the blog became one of the ways for Lehn and Dyer to stay in touch with a wide circle of family, friends and coworkers. New entries often generated a response within hours.

When Dyer read the comments aloud to her after her surgery, it was "so healing," Lehn said. "That was the nicest thing -- those words of encouragement."

The couple doesn't know anything about the donor, other than that it was likely a younger individual from the Toronto area. When the time is right, they plan to write a letter that will be forwarded to the family.

Lehn said she's giving long and careful thought to what she will say. "It's very generous of them because they're in their darkest grieving hours and they have to let go," she said.

The joy they feel will always be offset by the knowledge of someone else's pain, Dyer said.

"There's very few good things that come out of a loved one passing away," he said. "Being an organ donor is a way to find a meaningful legacy in what is otherwise a horrible, horrible event. It's important that you make that decision to become a donor and talk to your family about it."

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Scientists record first injured human donor lungs repair with gene therapy

This ground-breaking research in lung transplantation will have a global impact and I am very fortunate to have had the opportunity to see the initial lung perfusion technique being perfected using pig lungs. The senior scientist leading this research, Dr. Shaf Keshavjee, is the surgeon that performed my lung transplant more than 7 years ago and I am very pleased to report on this outstanding success.

Scientists hope to reduce inflammation in lungs donated for transplantation by maintaining them in a special perfusion chamber and using gene therapy to administer interleukin-10. (Photo credit: Nathan Sulyma, RN/Toronto General Hospital)

FOR the first time in the world, transplant surgeons at Toronto General Hospital, University Health Network, Canada, used a new technique to repair an injured donor lung that was unsuitable for transplant, and then successfully transplanted it into a patient. They said the use of this technique could significantly expand the lung donor organ pool and improve outcome after transplantation. CHUKWUMA MUANYA writes with agency reports.
Chukwuma Muanya The Guardian

FOR the first time, scientists in the McEwen Centre for Regenerative Medicine, University Health Network, Canada, have successfully used gene therapy to repair injured human donor lungs, making them potentially suitable for transplantation into patients. This technique could significantly expand the number of donor lungs by using organs that are currently discarded, and improve outcomes after transplantation.


In their pioneering work, a team of researchers led by Dr. Shaf Keshavjee, above, Senior Scientist at the McEwen Centre for Regenerative Medicine, University Health Network and Director of the Lung Transplant Program, University Health Network developed a technique of ex vivo gene delivery to donor lungs, before they are implanted into a recipient's body.

The technique was shown to be simple and effective in improving lung function. Their results, "Functional Repair of Human Donor Lungs by IL-10 Gene Therapy," are published in the October 28, 2009 edition of the journal Science Translational Medicine.

"This work is a big step in using regenerative strategies to repair injured lungs," says Keshavjee, who is also Director, Latner Thoracic Research Laboratories and Professor and Chair, Division of Thoracic Surgery at the University of Toronto. "For the first time, we hope to improve the health of donor lungs that we could not have used before by using gene therapy to decrease inflammation and repair cells before transplantation."

Keshavjee also emphasizes that clinical trials on humans would be the next step in testing this promising approach before it could be used on patients waiting for lung transplants. In these future clinical trials, lungs repaired with the gene therapy will be offered to patients waiting for a life-saving lung transplant.

The process of gene therapy used on injured lungs will be carefully explained to the patients and, if they consent, the patients will be potentially transplanted with the repaired lungs should no other suitable donor lungs become available.

"This work opens the door for a variety of therapies that could potentially be applied to repair various injuries in other donor organs to improve the safety and outcome of transplants," adds Keshavjee.

Using a novel approach to overcome some of the challenges of gene therapy, the researchers first developed a strategy to preserve lungs at normal body temperature, with the lungs kept outside the body in a protective dome.

The Toronto XVIVO Lung Perfusion System continuously pumps a bloodless solution of oxygen, proteins and nutrients into injured donor lungs, mimicking normal physiological conditions. This makes it possible for the injured cells to begin repairing themselves, and also sets the stage for more sophisticated repair techniques to be applied to donor lungs.

Working with pig and then human donor lungs, which were unsuitable for transplantation, the researchers first placed the lungs on the Toronto XVIVO Lung Perfusion System to warm them to normal body temperature. Then, using a specially engineered adenovirus vector -- a common cold virus -- the researchers used a bronchoscope to inject the vector with an added IL-10 gene through the windpipe into the human lungs.

The study found that lungs maintained on the Toronto Lung Perfusion System alone, the control group, did not deteriorate and remained stable. However, the donor lungs that received the gene therapy, in addition to the ex vivo perfusion, significantly improved their function with regards to blood flow throughout the lungs and their ability to take in fresh oxygen and get rid of carbon dioxide. The boosted IL-10 effect lasts for up to 30 days in the lung.

The authors state that transplanting lungs which function better from the start would lead to more predictable, safer outcomes, shorter periods of mechanical ventilation and shorter intensive care unit stays for patients.

"It's as if gene therapy turbocharges each individual cell to manufacture many more proteins in its own IL-10 factory," explains Keshavjee, "This protein down-regulates or decreases the inflammatory potential of cells injured before and during the transplant process. It also has the capacity to turn down the recipient's immune system which rejects the transplanted organ."

The IL-10 gene is found normally in animal and human cells, and plays a role in inhibiting the immune response to infection or foreign materials such as transplanted organs. The researchers found that the lungs begin producing the new IL-10 anti-inflammatory proteins about six hours after insertion.

More than 80 per cent of potential donor lungs are injured and show inflammation during the process of brain death and intensive care related complications, and cannot be used for transplantation. Moreover, inflammation and organ rejection are the two main complications after transplant surgery.

"Everything we can do to prevent lung injury, especially in the first 72 critical hours after surgery, would have a significant impact on survival and quality of life after transplantation," notes Dr. Marcelo Cypel, a transplant surgical fellow at Toronto General Hospital who is the first author of the paper. Cypel adds that patients who have severe early lung injury are at greater risk of dying after surgery, and have higher rates of organ rejection later on.

Currently, more than 50 patients are waiting for either a lung or heart-lung transplant in Ontario, Canada. About 20 per cent of those on the wait list will die before they receive a lung transplant. In Canada, the number of people waiting for a lung transplant has doubled in the past 10 years, with 252 Canadians waiting to receive a lung transplant in 2006, compared to 119 in 1997. Two hundred and ninety-nine (299) Canadians died while waiting for a lung transplant between 1997 and 2006.

It is estimated that the number of donor organs available for lung transplants could easily be doubled with this technique to treat and improve donor lungs.

Other members of the team who contributed to this study include: Mingyao Liu, Matt Rubacha, Jonathan Young, Shin Hirayama, Masaki Anraku, Masaaki Sato, Marc de Perrot, Thomas Waddell of the McEwen Centre for Regenerative Medicine and the University of Toronto; Jeffrey Medin, Ontario Cancer Institute, Princess Margaret Hospital; and Arthur Slutsky, St. Michael's Hospital.

The study was supported by grants from the Canadian Institutes of Health Research and the Center for Gene Therapy, National Institutes of Health, U.S.

“You Have the Power to Save Lives – Register to be a 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. One tissue donor can help up 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.

Surprise lung transplant gives mom renewed hope

By BARBARA TURNBULL Staff Reporter - The Toronto Star Healthzone.ca

"Be brave. Even when you are scared. Be Brave. Whatever it is, you can do it. Manage it. Overcome it."

– Natalia Ritchie

Just weeks ago, John Boguslawski was stoically waiting for his sister Natalia Ritchie, 30, to die of cystic fibrosis, the disease that was gradually destroying her lungs.

"I like it that there's an end to the road," he said then in a Star story on her harrowing ordeal. "I know that sounds cruel ... if she gets the lungs, this gets better. If she doesn't ... she goes and she doesn't have to continue (the fight)."

But on Saturday night he was Tweeting relatives and friends that Ritchie, the mother of a 4-month-old daughter, Scarlett, was about to undergo a 10-hour double lung transplant at Toronto General Hospital, giving her a new lease on a life.

"We just found out that the transplant is a go!!!" Boguslawski wrote on Ritchie's blog, Journey of a Lifetime, at 5:49 p.m. Saturday. "Please say a prayer for the family of the donor, someone just made the ultimate gift, but had to pay for it with his/her life."

Word of a possible transplant came around noon Saturday, three months, two weeks and a day after Ritchie was placed on the transplant list. Just days ago, her condition was so tenuous that doctors had placed her on a Novalung, a cutting-edge machine that oxygenates her blood and acts as an artificial organ, and can serve as a bridge to transplant when a situation is at its most critical.

"The surgery is going ahead. The lungs were deemed to be good and it should take about 10 hours," Boguslawski emailed triumphantly as surgeons prepared for the operation.

It is another chapter in what Ritchie herself has described as, "More than anything ... the story of great hope."

Last month, when she could still speak, Ritchie spoke of her hopes, and the knowledge that, whatever lies ahead, it won't be easy.

"If we get an extra five years or 15 years, those are going to be good years," she said then, filled with the hope conveyed by her medical team. "We're committed to making sure I get out of here in good form."

But, just in case, Ritchie has also spent hours writing her 4-month-old baby – born to a surrogate in July – telling Scarlett in words she cannot yet comprehend just how hard her mom is fighting to see her grow up.

"I have been thinking about how I can possibly write to you, about you, about us, when you are so tiny and brand new, knowing that you will read this when you are so much older," Ritchie wrote in one post.

"It's a funny thing. But I think about you in the future often, and think about what I will say to you when you're 5, 15, 25 ... I want to be there to say the things that I want you to know, but I might not be."

Last night Ritchie and her medical team took a giant step on the road to making possible that wish, to speak to her daughter years from now, to demonstrate that the power of love can sometimes vanquish even the worst of the body's betrayals.

But it won't be easy. Ritchie herself forecast the difficulties ahead.

"I want to do everything possible to protect this child from harm," she blogged last December of Scarlett, then still a dream for herself and husband Martin.

"Yet I know that my reality is theirs," Ritchie confessed.

"I know that they will always know more about illness, hospitals, IVs, infection, transplant, and the tough part of life than many of their friends.

"Yet I'd like to think that our little baby will also know so much love! They will see human will and the power of hope and determination. The power of faith and the power of family. The power of medicine, and our belief in it. The power of the country that we live in that makes sure I am as well as I can be.

"I could go on, and sometimes I do, to help myself overcome the fears that I have otherwise," Ritchie confessed.

She's already had a foretaste of what life, post-surgery, could turn out to be like.

In September, shortly after Scarlett's birth, Ritchie blogged of the joys of motherhood.

"I can sit her up on my leg and it's so nice for me! I can actually hold her without getting breathless."


Read her blog at: http://natandmarty.blogspot.com.

Follow her brother on Twitter http://twitter.com/jboguslawski

“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. 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. One tissue donor can help up 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.

Artificial lung saves man's life at Toronto General Hospital

I met Ken Thompson last June at the Lung Transplant Golf Tournament. The event is held each year to raise funds for lung transplant research at Toronto General Hospital (June 4th this year) and Ken was introduced as a lung recipient who was kept alive by the Novalung "bridge to transplant" until a donor lung was found for him. Here he proudly poses with other lung transplants at the June 5, 2008 tournament.

Ken Thompson (seated) poses with other lung transplant recipients:
Front: Al Jack, Merv Sheppard, Kellie Cooper, Judy Penner, Kim Cassar, Ken Thompson, Bob Webster
Back: Ralf Quast, Grant Hagerty, Avril Koyanagi

Have an opinion on this article? Click comments at the end of this post.

By Kurtis Elsner The Alliston Herald

Ken Thompson sits in a recliner chair in the living room of his Alliston home. He is covered with a blanket, and has difficulty moving. At times he has difficulty breathing. Surrounded by family, he listens closely as they recount his story. It's one he barely remembers, but one that doctors have called a miracle.

"They called him their miracle man, because they really didn't think he'd pull through," said Ken's wife, Ann.

It started in 2005, when Thompson went to his doctor because he had trouble breathing.

"I couldn't breath properly," he said. "I needed more air."

That year he was diagnosed with pulmonary fibrosis, a disease that destroys the lungs' ability to transfer oxygen to the blood stream. Since his diagnosis, Thompson and his family have been on an emotional rollercoaster ride that included a state-of-the-art piece of technology that kept him alive just long enough for a lung transplant.

"There were three times that (doctors) said, 'he won't make it, say your goodbyes'," said his 18-year-old daughter, Kayla.

After Thompson was diagnosed, he was put on oxygen to help him breath. He was able to live at home, but had to be hooked up to oxygen tanks at night.

In 2006, his condition worsened. By December of that year he could no longer work at his job at Borden Metals. Doctors increased his medication, and his family starting inquiring about getting Thompson on a list for a lung transplant, said Ann.

While family members were looking into the transplant list, Thompson's condition deteriorated and by late April of 2007 his family rushed him to Stevenson Memorial Hospital. A day later, doctors there sent him to Royal Victoria Hospital in Barrie. Kayla said she was warned he might not survive the trip. The family braced for the worst.

Thompson did make it to Barrie, but after a weeklong stay his condition deteriorated further and he was sent to Toronto General Hospital.

After a series of rigorous tests, Thompson was identified as a candidate for a transplant and was added to the long list of people awaiting donors May 17.

With Thompson's lungs failing fast, and the outlook for a donor unknown, on May 24 Thompson was put on a new technology known as a Novalung.

The German-made machine is hooked up to both of the patient's legs. Blood is pumped from one leg and into a machine that removes the carbon dioxide, and re-oxygenates the blood, before it goes back into the body through the other leg. The machine essentially temporarily replaces the patient's lungs when they fail.

Late on May 29, doctors said Thompson could only stay on the Novalung for another 12 hours, because of tissue damage to his legs, Ann said. Doctors would then have to disconnect it and let nature take its course. All the Thompson family and doctors could do was wait and see if a donor became available.

It was an excruciating wait, and one that's outcome was dependent on the tough decision of other families, said Ann.

"(The donor) has to be someone on life support," said Ann. "It's up to that family to say they're going to pull the plug."

Thompson's team of doctors cast a large net looking for lungs. At first the search was centered on Toronto, but eventually it opened up to across North America, Ann said.

Then, with little time remaining, the Thompsons received the news they had been waiting for - lungs were available, and they were from a patient in Toronto. Ann was asleep at the time, and she was woken up by two of Ken's sisters.

"They said, 'he has won the lottery. He's got lungs, he's got lungs coming," recalls Ann.

Preparation for the transplant began immediately. After what was about a six-hour surgery, Thompson had a new set of lungs. By the time doctors were able to take Thompson off of the Novalung, he had gone over the 12-hour threshold by 15 minutes. Doctors tried to repair the tissue damage from the machine, but Thompson has large holes and scars in his thighs, where the machine was hooked up.

Dr. Shaf Keshavjee is the director of the Toronto Lung Transplant Program, and he said the Novalung buys more time for people waiting for lung transplants. Unlike other artificial lungs, the Novalung does not require an artificial pump, and lets the patient's heart pump the blood. This means less damage to the body and fewer complications.

"Twenty per cent of the people that are listed for a lung transplant will die before they have an organ available for them," said Keshavjee. "So, for the few people that are candidates for this therapy, now you can put them on the Novalung and buy them some time until an organ becomes available."

For Thompson, his timing was lucky. He was one of the first people in Canada to go on the Novalung. Even now, two years later, the technology is rarely used in patients.

Keshavjee said Toronto General does about 100 lung transplants a year, and of those cases only about three or four go on the Novalung.

While the transplant saved his life, the whole ordeal continues to be a difficult one for Thompson and his family. He remembers little of his time in hospital, and his memory of things before the surgery has been hampered as well. He had a difficult time remembering Alliston when he returned, and didn't remember his house either.

"And I've lived in Alliston all my life too - 56 years," he said.

Since the transplant, there has been a series of medical hurdles Thompson has had to jump. He has had several medical complications, many of which Ann said likely stem from the cocktail of drugs Thompson has to take daily.

For example, every Monday morning he wakes up and takes 27 pills, consisting of both drugs and vitamins. He'll take over a dozen more before bed.

He has suffered seizures and fallen down. He had a throat stent because of tissue damage caused by intubation. He has also had difficulty walking, because of the damage to his legs caused when he was hooked up to the Novalung.

Despite the ups and downs, Thompson said he has received excellent support from his family and friends. His wife, Ann, has refused to give up, or let Thompson give up.

"It's been one hell of a rollercoaster ride, but if we ever had to do it again, we certainly would," she said.

Thompson has been improving, but he and his family have learned that progress is made with small steps. He has a physiotherapist come in to help him walk again, and Ann said she is determined to have him walking again by the spring. He had made some strides, and last summer was able to achieve one of his goals. He had regained some of his motor abilities, and was able to mow his lawn with a riding mower, a time he looks back on fondly and proudly.

But Thompson was admitted to hospital again this January, and after a month-long stay, he has had to start over once again.

The father of two's biggest goal is learning to walk, and thankfully he has a major motivation to accomplish it - his daughters, Kayla and Kendal.

"My dad and I are best friends. He's my life," said Kayla. "He's my miracle."

Kayla still lives at home, and she and her fiancé, Max Kueper, help with Thompson's recovery. While the help and support from his family is greatly appreciated, his daughter's engagement especially has given Thompson all the motivation he needs.

"I have to walk my daughter down the aisle," he said.

Merv's note: For more info and a video about the Novalung device see my recent post about 16-year-old Katie Sutherland who's life was also saved by the Novalung

“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

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. One tissue donor can help up to 100 other people by donating skin, corneas, bone, tendon, ligaments and heart valves

New transplant hope as lung is 'repaired' and given to patient

X-Ray: Doctors have for the first time repaired an injured donor lung and transplanted it into a patient

I attended the press conference at Toronto General Hospital announcing this scientific breakthrough that will have a global impact on organ transplantation. It was also my pleasure to be taken for a tour of the labs to see these experiments first hand and I'm still in awe of the amazing advances that Dr. Shaf Keshavjee and his lung transplant team have achieved. See my blog post for more details and photos. Merv.

By JO MACFARLANE Daily Mail, UK

Surgeons have for the first time repaired an injured donor lung and transplanted it into a patient.

The lung did not meet strict quality standards and would normally have been discarded. But, using a new technique, doctors kept it ‘alive’ and repaired it with a combination of drugs and stem cells.

Lungs are usually removed from patients who die of brain injuries. But because the brain releases inflammatory enzymes when it shuts down, only about 15 per cent are viable for transplant.

These healthy organs are then cooled and are usable for about six to eight hours.

Under the new procedure, the lungs are transferred to a protective chamber and connected to ventilators and filters, which allow an oxygen-carrying solution to flow through them.

The temperature of the lungs is increased over 30 minutes until it reaches 37C (99F), at which point they can be preserved for between 12 and 18 hours, allowing doctors to assess the quality of the organ and treat it accordingly.

The lungs also partially use their own regenerative powers to heal in the same way they would inside the body.

The system was developed in Toronto, Canada. Lead researcher Shaf Keshavjee said: ‘This will be a significant improvement in the utilisation, and quality of organs.

'It has applications for all organs, and transplantation will become more like blood banks, with organs tested and then stored.’

The technique has been successfully used in four transplants.

“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

I wish everyone all the best for 2009

Breathing life into injured lungs: world-first technique will expand lung donor organ pool

click here for video of breathing lung
click here for enhanced view of an ex vivo lung

"After the donor lungs are removed from a deceased donor and taken to the hospital, they are carefully transferred to a protective, transparent bubble-like chamber that the Toronto team developed in collaboration with Vitrolife, a company specializing in developing lung preservation solutions.

"To avoid injuring the lungs, a series of precise steps are followed when connecting them to a circuit composed of a pump, ventilator and filters through which flow oxygen, nutrients and a special solution The temperature is incrementally increased until it reaches 37 degrees Celsius over about 30 minutes, and ventilation of the lungs is begun during that time."

I was honored to participate in the news conference in Toronto announcing this medical breakthrough that will ultimately save many more lives by getting more patients off the waiting lists and giving them the 'Gift of Life'.

Congratulations to the surgeon who saved my life with a single lung transplant, Dr. Shaf Keshavjee and his Lung Transplant Team for this achievement that will have a global impact. Merv.

December 19, 2008
TORONTO — University Health Network

For the first time in the world, transplant surgeons at Toronto General Hospital, University Health Network used a new technique to repair an injured donor lung that was unsuitable for transplant, and then successfully transplanted it into a patient.

The use of this technique could significantly expand the lung donor organ pool and improve outcomes after transplantation.

In their ground-breaking research, a team of lung transplant surgeons led by Dr. Shaf Keshavjee in the Lung Transplant Program at Toronto General Hospital (TGH) developed an “ex vivo” or outside the body technique capable of continuously perfusing or pumping a bloodless solution containing oxygen, proteins and nutrients into injured donor lungs.

This technique, the Toronto XVIVO Lung Perfusion System, allows the surgeons the opportunity to assess and treat injured donor lungs, while they are outside the body, to make them suitable for transplantation.

Unlike current cooling lung preservation techniques which inhibit cell metabolism and the possibility of any active repair processes prior to transplantation, the Toronto technique maintains donor lungs at a normal body temperature of 37 degrees Celsius, allowing for future organ repair and gene and cell therapy strategies to be used on them.

Although lung perfusion systems have been used in Sweden and England, these systems were blood-based, short-term assessment strategies which were not capable of long-term maintenance or techniques to repair or recondition the lungs.

The Toronto System was used on donor lungs for Andy Dykstra, 56, who received his transplant on December 5, 2008. He had been waiting for a transplant since July 30, 2008, and was told of the clinical trial testing the new system on December 4, 2008.

Recalling his difficulty breathing when walking to the front door in his home, Andy said that he waited only two seconds before deciding to be the first patient to receive the reconditioned lungs, which would not have been suitable for transplant without undergoing perfusion by the Toronto System.

“When I was given this chance, the hair on my arms stood up, I was so excited. I knew it was right. I just had to go for it,” he said, with his wife Chris standing by his side and nodding for emphasis.

Andy is part of an ongoing clinical trial which uses the novel Toronto strategy to identify donor lungs which do not meet current transplant criteria, repair them, and then transplant them into patients. To date, four patients in total have received lungs treated using this technique, and all have done well.

But Andy was the first patient who received lungs which did not meet standard transplant criteria and which could not have been used if they had not been repaired first by the Toronto System. (The three others received donor lungs which met transplant criteria and which were further improved by the Toronto System.)

All TGH patients waiting for a lung transplant are eligible to be part of this clinical trial, and the lung transplant team will assess all those who are interested.

“We are extremely pleased that Andy is doing so well,” said Dr. Keshavjee who is Director of the Lung Transplant Program at TGH, Senior Scientist, The McEwen Centre for Regenerative Medicine, Director, Latner Thoracic Research Laboratories, and Professor and Chair, Division of Thoracic Surgery, University of Toronto, adding that Andy was able to breathe without any mechanical assistance just four days after the transplant and was discharged from hospital 12 days after the procedure.

“This achievement was the result of years of research and pre-clinical planning by a large team of researchers, surgeons, physicians, nurses and other specialists. It means that many more donor lungs which we could not have used before can now potentially be used safely, and it sets the stage for more sophisticated molecular and cellular repair techniques to be applied in the Toronto XVIVO Perfusion System so that transplant outcomes can be further improved. The potential exists to immunologically pre-prepare the organ before it even sees the recipient’s immune system.”

He explained that currently only about 15%-20% of donor lungs are acceptable for transplantation since lungs are susceptible to injuries during the brain-death process or from intensive care unit-related lung complications. These numbers can easily be doubled with this technique to treat and improve donor lungs.

Dr. Marcelo Cypel, a transplant surgical fellow at TGH, echoed Dr. Keshavjee’s sentiments. “This new technique heralds the beginning of a new era in transplantation since it has allowed us to progress from preserving donor lungs to actually being able to repair some of the injury before transplantation. And we have done this using a unique strategy on donor lungs outside the body.”

After the donor lungs are removed from a deceased donor and taken to the hospital, they are carefully transferred to a protective, transparent bubble-like chamber that the Toronto team developed in collaboration with Vitrolife, a company specializing in developing lung preservation solutions.

To avoid injuring the lungs, a series of precise steps are followed when connecting them to a circuit composed of a pump, ventilator and filters through which flow oxygen, nutrients and a special solution The temperature is incrementally increased until it reaches 37 degrees Celsius over about 30 minutes, and ventilation of the lungs is begun during that time.

Lung function is evaluated regularly on key indicators, such as how easily the lungs can exchange oxygen, airway pressure and lung compliance.

Previously published research by Drs. Keshavjee and Cypel on this system (December 2008 issue of the Journal of Heart and Lung Transplantation) has shown that lungs can be safely kept on this circuit for 12 hours in order to assess, maintain and treat them before successfully transplanting them.

Currently, about 80 patients are waiting for either a lung or heart-lung transplant in Ontario. About 20% of those on the wait list will die before they receive a lung transplant.

In Canada, the number of people waiting for a lung transplant has doubled in the past 10 years, with 252 Canadians waiting to receive a lung transplant in 2006, compared to 119 in 1997. Two hundred and ninety-nine (299) Canadians died while waiting for a lung transplant between 1997 and 2006.

The clinical trial is funded by Vitrolife Inc. and is approved by the Research Ethics Board of University Health Network.

A Canadian Institute for Health Information report this week showed that 299 people died while waiting for a lung transplant between 1997 and 2006.

However, the number of lung transplants increased to 171 in 2006 from 93 in 1997, while the three-year survival rate has improved to 80 per cent in 2003 from 60 per cent in 1997, CIHI 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

Giving new life to lungs for transplantation

This article gives an excellent overview of the ex-vivo lung perfusion technique that many centers are now using in studies with lung transplants. Toronto General Hospital, where I had my lung transplant, is one of the leading centers doing this. If successful this will greatly increase the number of donor lungs suitable for transplant and save many more lives in the future.

By Eoin Burke-Kennedy IRISHTIMES.com

AN EXPERIMENTAL lung transplant procedure, carried out in Britain in September, could increase the number of organs available for transplant and significantly reduce the number of patients on transplant waiting lists.

Surgeons at University Hospital of South Manchester (UHSM) successfully transplanted donor lungs that had been made to breathe outside the body.

The technique, known as "ex-vivo assessment", allows doctors to assess the quality of lungs after they have been removed from the donor.

This is particularly important in transplant medicine, as donor organs can be impaired by the process of death or by repeated resuscitation attempts at the point of death and thereby rendered unfit for transplant.

During the procedure, the lungs are removed from the donor and hooked up to a machine and pumped with blood and oxygen. This is to keep them functioning for longer than they would normally survive outside of the body.

After a period on the machine, the lungs, which may have been deemed sub-optimal for transplantation while in the donor, may recover sufficient functionality to be used safely in a transplant.

The procedure, which was first developed in Sweden, is estimated to increase the number of organs available for transplant by 25 per cent.

The surgical team in Manchester is the first outside Sweden to successfully carry out a lung transplant using the "ex-vivo assessment" method.

The director of transplant at UHSM, Mr Nizar Yonan, says the number of people on waiting lists for lung transplants in most countries is significantly larger than the number of lungs procured from "heart-beating" donations.

Unfortunately, this means that a significant number of patients do not survive long enough to get a transplant, he says. "So the pressure has been on us for some time to expand the criteria for accepting lung donations.

"The problem is that many donor organs look good at an early stage but when you assess them just prior to transplant, the results can be sub-optimal, forcing us, under the current guidelines, to cancel the transplant procedure because of concern about how the organs will function in the recipient."

However, Yonan says the sub-optimal assessment is often caused by a deterioration in the donor's body at the point of death and not necessarily because of any inherent problem with the lungs themselves.

"With some brain trauma patients, for example, you can get neurogenic pulmonary oedemas where there is build-up of fluid on the lungs impairing gas exchange and ultimately causing respiratory failure," he says.

"Even though we feel the lungs would be safe to transplant, as they do not have any injuries, say from inhalation or pneumonia, we cannot be 100 per cent sure that they would function effectively in the recipient."

He says with the "ex-vivo assessment" method the lungs are removed from the body in the normal way but instead of implanting them they are connected to a circuit and perfused with a blood and oxygen mix.

Once the blood flow and ventilation are normalised, the oxygen supply is then removed, allowing the lungs ventilate on their own and oxygenate the blood coming through the circuit, thereby mimicking normal physiological conditions.

This gives doctors a chance to assess the lung function outside the donor's body.

"By adding a special solution to the circuit, we can also remove any extra fluid in the lungs. So it is not just assessment, there is partial resuscitation," Yonan says.

The UHSM recently discharged a 55-year-old man following a successful double-lung transplant using the method.

"We have around 30 patients who have consented to be transplanted using ex-vivo organs and I am confident that many lives will be saved using this technique," he says.

There are 33 patients in the Republic awaiting lung transplant operations.

About 40 per cent of these patients are cystic fibrosis sufferers. The remainder suffer from various lung diseases such as idiopathic pulmonary fibrosis and emphysema.

Prof Freddie Wood, the director of the National Heart and Lung Transplant Programme at the Mater Hospital in Dublin, says the Republic can harvest about 12.5 per cent of the viable lungs made available through multi-organ offers.

This equates to about one to two lungs per year, because of the difficulty in matching recipients and donors in terms of size and blood group.

The Mater is currently reviewing its heart and lung transplant procedures with the aim of adopting new technologies, similar to the one being used in Manchester.

Wood says the ex-vivo assessment technique appears to have "considerable potential" but further results would need to be assessed before it could be adopted by other transplanting groups.

He believes the new technologies must be complemented with the adoption of a national donor management strategy similar to those developed in Canada and Australia.

He cites Ontario's donor management system which has increased its organ donation yield from 12.5 per cent to 50 per cent.

"If we could obtain similar results here then we would suddenly provide for all the patients waiting for transplantation in Ireland."

There has been four double-lung and 16 single-lung transplantations performed at the Mater hospital since the establishment of the National Heart and Lung Transplant Programme in 2005.

All patients have survived except for one individual who died 11 months after the operation.

One of the main risks posed by transplant procedures, apart from whether the newly transplanted organ will function properly, is the problem of organ rejection.

The recipient's immune system may see it as an invader and attack it because the transplanted lung or lungs come from another person.

Patients are put on a regimen of immuno-suppressive drugs to prevent organ rejection.

However, these drugs can significantly impair the body's immune function increasing the chances of infection and so patients must be closely monitored.

Wood says 90 per cent of lung transplant patients who are discharged from hospital are alive in year one and 66-70 per cent are alive in year four.

He says the survival rates have improved significantly in the past 10 years with the development of more effective drugs and the improved detection of rejection episodes.

However, he says, the lungs are a particularly difficult organ to monitor and if you are getting chronic rejection problems, there is nothing else to fall back on, in contrast with the kidneys, for instance, where you can put a patient back on dialysis.

"Although the rejection rate with the lungs is no greater than other organ transplants, we don't have any support mechanisms to keep people going if their transplanted organ fails."

“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

In Praise of The Lung Transplant Team at Toronto General Hospital

I've come a long way since these first days of my "second chance". This April 20th will mark the four-year anniversary of my single-lung transplant. And what a wonderful four years it's been! I experienced the miracle of receiving life from where there was virtually no life and this has changed me forever. I feel better today than I have for many years with boundless energy and a feeling of overall well being. I will be eternally grateful to my donor and his or her family and the wonderful Lung Transplant Team at the Toronto General Hospital division of the University Health Network.

This year's Rose Parade theme was "It's Magical" and the Donate Life float's theme was "Life Transformed". This could not be more apt or appropriate, at least in my case. My transplant touched my life by giving me the "Gift of Life". It has transformed me physically, emotionally and spiritually. My lung transplant has had a profound, and yes, magical, impact on my life, as I'm sure organ and tissue transplantation has helped hundreds of thousands of people regain their health with the same impact on their lives, families and friends. Speaking of friends, many of the best friends I have ever known I only met since my transplant, through the special bond that exists in our transplant community.

A noted cardiologist said on TV how impressed he was with the monitoring and follow-up transplant patients receive and how he wished all patients could have the same attention.

That got me to thinking about the follow-up I've received as a pre and post lung-transplant patient and it's been absolutely second to none. I have never been more impressed with any group more than with The Lung Transplant Team at Toronto General Hospital, from the doctors to the nurses, transplant coordinators, the Support Group, physiotherapists, respiratory and pulmonary function technologists, and other support staff and technicians. This also includes the staff at Toronto Western Hospital where I have various tests and procedures from time to time. At first, because I was treated so royally, I thought they might have mistaken me for a Head of State or other V.I.P. until I learned that every patient is treated this way. It is very obvious they are not just doing a job, but have a compassionate interest and dedication to their patient's optimal recovery and well being.

In addition to my regular clinics and visits, I received a steady stream of calls and messages from "the team" since my discharge. This was further emphasized for me recently; I missed getting my monthly blood work done when it was scheduled and sure enough, my transplant coordinator was on the phone to find out why. With all this attention it would be easy to think I was the only patient they had. But I happen to know The Lung Transplant Team has a caseload of hundreds of patients at various stages of follow-up and treatment. How they do it I don't know, but it must involve a lot of hours, passion for their career and hard work.

Not only have I been given the gift of life but is very comforting to know that there is a team of people monitoring and watching over me to make sure that my gift of a single-lung transplant survives and stays part of me for a long time to come. So, whether you are waiting for a transplant, post-transplant or a support person or friend, I feel you and yours could not be in better hands than those of the Toronto General Hospital Lung Transplant Team!