Experience with the first 50 ex vivo lung perfusions in clinical transplantation

J Thorac Cardiovasc Surg 2012;144:1200-1207
© 2012 The American Association for Thoracic Surgery 

Cardiothoracic Transplantation

Experience with the first 50 ex vivo lung perfusions in clinical transplantation
Marcelo Cypel, MD, MSc, Jonathan C. Yeung, MD, PhD, Tiago Machuca, MD, Manyin Chen, MD, Lianne G. Singer, MD,Kazuhiro Yasufuku, MD, PhD, Marc de Perrot, MD, MSc, Andrew Pierre, MD, MSc, Thomas K. Waddell, MD, PhD,Shaf Keshavjee, MD, MSc^_*
Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada

Read at the 92nd Annual Meeting of The American Association for Thoracic Surgery, San Francisco, California, April 28-May 2, 2012.

Received for publication April 25, 2012; revisions received July 8, 2012; accepted for publication August 1, 2012.
^_* Address for reprints: Shaf Keshavjee, MD, MSc, Toronto Lung Transplant Program, Toronto General Hospital, 200 Elizabeth St, 9N946, Toronto, ON, Canada. (Email:shaf.keshavjee@uhn.ca).

Objective: Normothermic ex vivo lung perfusion is a novel method to evaluate and improve the function of injured donor lungs. We reviewed our experience with 50 consecutive transplants after ex vivo lung perfusion.

Methods: A retrospective study using prospectively collected data was performed. High-risk brain death donor lungs (defined as PaO ₂/FIO ₂ <300 mm Hg or lungs with radiographic or clinical findings of pulmonary edema) and lungs from cardiac death donors were subjected to 4 to 6 hours of ex vivo lung perfusion. Lungs that achieved stable airway and vascular pressures and PaO ₂/FIO ₂ greater than 400 mm Hg during ex vivo lung perfusion were transplanted. The primary end point was the incidence of primary graft dysfunction grade 3 at 72 hours after transplantation. End points were compared with lung transplants not treated with ex vivo lung perfusion (controls).

Results: A total of 317 lung transplants were performed during the study period (39 months). Fifty-eight ex vivo lung perfusion procedures were performed, resulting in 50 transplants (86% use). Of these, 22 were from cardiac death donors and 28 were from brain death donors. The mean donor PaO ₂/FIO ₂ was 334 mm Hg in the ex vivo lung perfusion group and 452 mm Hg in the control group (P = .0001). The incidence of primary graft dysfunction grade 3 at 72 hours was 2% in the ex vivo lung perfusion group and 8.5% in the control group (P = .14). One patient (2%) in the ex vivo lung perfusion group and 7 patients (2.7%) in the control group required extracorporeal lung support for primary graft dysfunction (P = 1.00). The median time to extubation, intensive care unit stay, and hospital length of stay were 2, 4, and 20 days, respectively, in the ex vivo lung perfusion group and 2, 4, and 23 days, respectively, in the control group (P > .05). Thirty-day mortality (4% in the ex vivo lung perfusion group and 3.5% in the control group, P = 1.00) and 1-year survival (87% in the ex vivo lung perfusion group and 86% in the control group, P = 1.00) were similar in both groups.

Conclusions: Transplantation of high-risk donor lungs after 4 to 6 hours of ex vivo lung perfusion is safe, and outcomes are similar to those of conventional transplants. Ex vivo lung perfusion improved our center use of donor lungs, accounting for 20% of our current lung transplant activity.

“You Have the Power to Donate Life – Sign-up today! Tell Your Loved Ones of Your Decision”

Canada Ontario, Canada - British Columbia, other Canadian provinces

United States, organdonor.gov

United Kingdom, register at NHS Organ Donor Register

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

Lung transplants get a little time on their side

Doctors aim to get organs into the recipient as soon as possible. But a new study finds that treating organs on a perfusion machine for several hours before transplantation may increase success.

Surgeons treat donated lungs prior to transplantation at Toronto General Hospital. (Toronto General Hospital)

"We won't just transplant an organ," said Dr. Shaf Keshavjee, senior author of the study and director of the Toronto Lung Transplant Program at Toronto General Hospital. "We will diagnose it, fix it, make it OK and then transplant it."

By Shari Roan, Los Angeles Times

For decades, heart and lung transplant surgeons have followed a strict directive: Get the donor organ into the recipient as soon as possible.

That practice may be changing. In a study published Wednesday in the New England Journal of Medicine, researchers said both the number of donor lungs and successful transplants may be dramatically increased by treating the organs on a perfusion machine for several hours before transplantation.

The technique marks a paradigm shift in the transplantation field, experts said. About 85% of lungs made available for donation are not used because of tissue damage that potentially could be repaired with perfusion or other techniques.

"We won't just transplant an organ," said Dr. Shaf Keshavjee, senior author of the study and director of the Toronto Lung Transplant Program at Toronto General Hospital. "We will diagnose it, fix it, make it OK and then transplant it."

Variations on the pre-transplant treatment concept are also being tried on kidneys, livers and hearts. Lungs, however, provide a unique opportunity because they are greatly needed and appear so amenable to perfusion treatment, said John Dark, a professor of cardiothoracic surgery at Newcastle University in England and president of the International Society for Heart and Lung Transplantation.

"This is the most exciting advance in lung transplantation since we first started 25 years ago," said Dark, who was not involved in the study. "It's converting lungs you can't use into lungs you can use. At the moment, we are only using about 20% worldwide of the lungs that are offered to us."

In the U.S., 1,786 people are on the waiting list for a lung transplant, according to the Department of Health and Human Services' Organ Procurement and Transplantation Network. About a third of the patients wait at least three years for a suitable pair of donor lungs, and about 10% to 15% die before receiving a transplant.

Lungs must be able to function immediately once transplanted. For that reason, surgeons are selective about which lungs they use and accept only those in the most pristine condition, Keshavjee said. That poses a challenge because lungs are easily damaged from injury or in the final stages of terminal illness.

The new technique pumps a liquid consisting of oxygen, proteins and nutrients into the donor lungs after they've been removed and transported to the recipient's hospital. Keshavjee and his team used the Toronto XVIVO Lung Perfusion System, which was designed for this purpose. The system is being used around the world but is not yet approved by the Food and Drug Administration for use in the U.S.

Researchers treated 23 sets of lungs that were impaired in some manner — and would have been rejected for transplant — with perfusion for four hours and transplanted 20 of them that looked viable after the treatment. Surgery outcomes were compared with those of 116 patients who received conventional donor lungs.

After 72 hours, 15% of the patients who received treated lungs suffered primary graft dysfunction, a potentially fatal complication, compared with 30% of the patients in the control group. After 30 days, the rate of deaths, complications and hospital stays were similar between the two groups.

The perfusion technique essentially repairs damage caused by swelling or inflammation in the lung, Dark said. That opens the door to other types of treatments for organs after they have been removed from a donor's body, including antibiotics, gene therapy or even immunosuppressant medications that might lower the risk of rejection.

But estimates on how the technology will effect organ transplantation vary.

"There is still some discrepancy from the transplant community on whether this will really bring significant benefit," said Dr. Christian A. Bermudez, associate director of heart and lung transplantation at the University of Pittsburgh School of Medicine. "There is no doubt it would increase the complexity of the procurement. But it may be a good strategy that would allow some increase in the organ utilization."

Pre-transplant treatment of an organ would add significant cost to transplant surgeries. And if the organ was treated and still deemed unsuitable for transplant, it's not clear who would pay for the failed treatment, Keshavjee said.

"There are things to be ironed out," he said. "The evidence is mounting in favor of it, but it's radically different."

Merv's note:
Watch the video of Dr. Keshavjee's presentation at the TEDMED Conference in San Diego as he unveiled a breathing lung on stage and describes how the Toronto EXVIVO Lung Perfusion System reported above is saving lives.

“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

Lung recipient doing well after EXVIVO Lung Perfusion procedure

I'm very pleased to see that Christina Foster is doing well after receiving lungs that have been made viable for transplantation by the Toronto EXVIVO Lung Perfusion System. I spoke with Dr. Shaf Keshavjee (the surgeon that performed my lung transplant in 2002) a couple of weeks ago and at that time 30 patients had already received new lungs that would have previously been unacceptable for transplant. Only about 15% percent of donor lungs turn out to be usable because of some type of defect in the other 85%. The EXVIVO system developed by Dr. Keshavjee and his team at Toronto General Hospital is having a global impact on lung transplantation and has made Canada a world leader in this area.

Researchers used the Toronto XVIVO Lung Perfusion System to continuously pump a bloodless solution of oxygen, proteins and nutrients into injured donor lungs, mimicking normal physiological conditions and warming the lungs to normal body temperatures. This makes it possible for the injured cells to begin repairing themselves, and also sets the stage for gene therapy repair techniques to be applied to donor lungs. Read more at the following posts:

Donated Lungs Breathing Outside Body
Ex-vivo Lung Perfusion
Scientists use gene therapy to repair injured donor lungs

Posted By ELAINE DELLA-MATTIA, THE SAULT STAR

Sault Ste. Marie, Ontario - Christina Foster can breathe a little easier now.

The 32-year-old Saultite has received a new set of lungs and is continuing her rehabilitation at her temporary Toronto-area home.

She's hopes be back home in Sault Ste. Marie for Christmas.

Foster, said she can't believe the difference in the way she feels and the simple things in life that she can do again.

"I'm doing things I haven't done in years, like just walking at a certain pace," she said in a telephone interview.

Foster received her new lungs on Aug. 10 and after a 10-day stay in hospital, was released.

She got a call shortly after midnight on Aug. 10 from hospital officials who said they "might" have a set of lungs for her.

Foster and her husband went to Toronto General, where they waited until 8 a.m. and were told she'd get the lungs.

"We were told that it could always be a false alarm and that often on the first try, it is, so you're prepared," she said.

By 10 a.m. that day, Foster was in surgery, which would last until about 5 p.m.

She was taken off respirators at 2 p.m. the following day, was out of intensive care two days later and home on day 10 of her stay.

"It all happened incredibly fast," she said. "We were told to expect to be in the hospital at least three weeks, likely a month."

Foster was also involved in a study at Toronto General Hospital where they put the lungs into a "cleaner" called the Ex Vivo Lung Perfusion system, which her surgeon helped invent.

That helped clean the lungs and analyze them outside of the donor to prepare them for the transplant.

Foster has been told that without the new cleaning technology, the lungs might not have been suitable for her.

Foster is freed of the oxygen she was on around the clock prior to her surgery. She also doesn't cough anymore.

And her lack of oxygen, even with the help of a machine, often meant she had to travel in a wheelchair -- something that is now being returned to the hospital.

"I'm walking and exercising and my oxygen levels are at 99%," she said.

Foster is still unable to lift anything, including her two-year-old son.

She currently attends physiotherapy sessions three times a week at the hospital in order to rebuild the muscles she lost prior to surgery.

The physio and other routine hospital visits to check her blood and lungs are expected to continue for the next three months.

Foster, who also has no immune system at this time, has to be careful and watch for infections or rejection of the lungs and does routine testing at home.

Foster, a graduate of Sacred Heart Catholic school and St. Mary's College, was born with cystic fibrosis, a multi-organ disease, primarily affecting the lungs and digestive system.

The Central Algoma Secondary School teacher's health had been deteriorating since late last year and her lungs deteriorated to the point where doctors fast-tracked her on the list to receive an organ donation.

Her husband Robert, a teacher at Bawating Collegiate, has taken the semester off work to be with Christina during her recovery.

Foster said she has been very fortunate.

Several fundraising efforts raised about $50,000 to help cover the costs of living in Toronto.

A dinner was held at Riuniti banquet hall last spring and the staff at CASS held an arts night.

As well, a friend, Kathryn Peradis completed a half marathon in the United Kingdom for Foster.

Her sister-in-law Selby Foster and her father, Randy Johnson, are starting a bike-a-thon this Friday from the Sault to St. Catharine's for cystic fibrosis awareness with the proceeds going to the family.

The bike-a-thon is moving ahead with the donation of two bikes, one from Stan Hemphill, the other from Velorution bike shop.

Donations to the fundraiser can be made through the website http://www.coughupforalung.com/ or on the Facebook site Cough-Up for a Lung.

"Sault Ste. Marie has been amazing to us," Foster said. "It's been very overwhelming and all the support has done a lot to take the pressure off during these hard times," 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

Reconditioned lungs used in UK transplant

It's gratifying to see that more centers, such as the Freeman Hospital in the UK, are using the Ex-vivo (outside the body) Lung Perfusion System that allows surgeons the opportunity to assess and treat injured donor lungs, while they are outside the body, to make them suitable for transplantation. Read my earlier post on the World-first Toronto XVIVO Lung Perfusion System.

Research breakthrough gives new life to lungs for transplantation

BBC News

Donor lungs normally rejected as too damaged can now be 'reconditioned' for transplant, say doctors.

Cystic fibrosis patient James Finlayson is the first in the UK to receive lungs revived using oxygen, nutrients and antibiotics.

Newcastle-based scientists and surgeons suggest it could eventually double the number of available organs.

Current shortages mean that many patients die waiting for their operation.

The fragile nature of the lung means that it is far more vulnerable to damage during the final hours of life.

At present, four out of five potential donor lungs turn out to be unsuitable, but the recent operation at the Freeman Hospital in Newcastle was the first in the UK to use one of these 'rejected' organs.

The technique involves connecting the lungs to a heart bypass machine then pumping a tightly-controlled solution of oxygen, proteins, antibiotics and nutrients over the damaged tissues.

This helps reduce inflammation, and even allows some damage to be repaired.

Regular checks are made on the ability of the lung to do its job of exchanging oxygen and maintaining airway pressure.

After approximately six hours, the lung has been improved sufficiently to be transplanted into the patient.

'Poor condition'

Mr Finlayson was discharged from hospital at the end of November, and is said to be recovering well.

Professor Andrew Fisher, from the Institute of Cellular Medicine at Newcastle University, said that the lung chosen for the pioneering operation had been in such poor condition that it would have been "rejected outright" by any transplant centre in the world.

He said: "We now have the potential to double the number of lungs available for transplant - it will offer new hope to a great number of patients."
Canadian surgeons have been using the technique for approximately a year longer, and Professor Fisher said that early signs showed similar survival rates for patients given "reconditioned" lungs.

He said that other UK transplant centres were now involved in work to use the technique more widely, but that greater investment would be needed in transplant services if the number of operations were to rise significantly.

The research was funded by the Cystic Fibrosis Trust, and a spokesman said that hundreds of people with the disease, and other lung conditions, could benefit.

She said: "At present, around half of those with Cystic Fibrosis on the transplant list die waiting for donor lungs."

Dr Keith Prowse of the British Lung Foundation said: "This is a very exciting procedure and if it leads to more lungs being available for transplant operations, it will be a hugely welcome development.

"There is an increasing demand for lung transplants but just not enough lungs available."

“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. 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.

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.

New technique to repair lungs outside the body may double transplants worldwide

Dr. Shaf Keshavjee (above), the surgeon that performed my lung transplant in 2002, is a world leader in lung transplantation and lung transplant research. His body of work is having a global impact and this article exemplifies that. The XVIVO Lung Perfusion Technique has the potential to double the number of lungs available for transplant, not only in Toronto, Canada but worldwide as other centers adopt the technique.

Canadian Institutes of Health Research (CHIR)

Research Profile July 2009

In a room at the Toronto General Hospital (TGH), a pair of human lungs is breathing inside a glass dome. As they breathe in and out, fed by a supply of gases and nutrients, the lungs are healing themselves from injury. This revolutionary technology promises to improve the fate of many patients waiting for lung transplants in Canada.

In Canada, nearly 300 patients with lung disease died between 1997 and 2006. These patients died because of a shortage of suitable lungs available for transplant. In fact, as few as one in 10 donated lungs available can be used. The new technology at TGH may allow doctors to more than double the number of lung transplants done worldwide, according to Dr. Shaf Keshavjee of TGH's Division of Thoracic Surgery.

"Lungs are very fragile as organs," says Dr. Keshavjee, who directs the Toronto Lung Transplant Program. "This new system allows you to assess the lungs, to diagnose what's wrong with them, and then repair them."

Dr. Keshavjee's team worked for years studying lung transplant and repair experiments on animal models. In December 2008 they announced a successful first use of the system in transplanting a pair of lungs into a patient. They have since completed twelve other successful transplants with the system, called The Toronto XVIVO System.

The work is being funded by the Canadian Institutes of Health Research's CIHR/Rx&D Collaborative Research Program, a partnership of CIHR and Canada's Research-Based Pharmaceutical Companies. Other collaborative partners include Astellas Canada, Wyeth Pharmaceuticals and Vitrolife Inc.

The Toronto XVIVO Lung Perfusion System was developed by Dr. Keshavjee's team and Virolife Inc., which specializes in lung preservation. The technique allows lungs to be kept at body temperature, outside the body. Fed with a bloodless solution containing nutrients, proteins and other medications, the organs exchange oxygen and carbon dioxide through a ventilator and can repair themselves while the researchers facilitate the recovery and check them. The lungs can be kept inside the device for up to 18 hours, though 12 hours is the current routine limit. A similar blood perfusion system developed in Sweden for short term assessment only works for about an hour before the lung becomes damaged.

"We've already successfully transplanted twelve* patients now using the XVIVO System, so those patients received lungs that couldn't have been used before," says Dr. Keshavjee. "They've all done superbly, every single one of them. We're now able to use lungs that we couldn't use before."

*As of today, Dr. Keshavjee tells me that 14 patients have now been transplanted - Merv.

The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency responsible for funding health research in Canada.

NOTE: Also read the article at physorg.com.

“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

Donated Lungs Breathing Outside the Body (Video)

Dr. Shaf Keshavjee told me that as of June 4th they have now performed eleven very successful lung transplants using this new Toronto Exvivo technique which means that eleven more patients are alive because they could use this novel strategy to assess and treat donor lungs. All patients are doing very well and this bodes well for the future by increasing the number of donor lungs available for transplant and getting patients off waiting lists. Dr. Keshavjee also said that they have already taught this EXVIVO technique to fifteen lung transplant surgical teams worldwide and surgeons at the Harefield-Brompton Hospital in the UK have recently performed their first successful exvivo lung transplant using the Toronto technique.

By Drew Halley Singularity Hub Blog

Pop quiz! What’s weirder than dead organs sitting around in glass jars? Live organs moving around in glass domes.

For patients with late-stage respiratory diseases, finding a new pair of lungs can be… well, about as hard as it sounds. Currently, about four out of five lung donations are rejected for use, as they don’t fit the criteria required for a safe transplant. Keeping an organ alive outside the body is tricky stuff, especially long enough to patch it up. But what if doctors had enough time to repair donated organs that were initially unfit for transplant?

For the first time, doctors at Toronto General Hospital have used what is called the XVIVO Lung Perfusion System to repair donated lungs. Using a ventilator, pump and filter, the new technique can keep lungs breathing in a glass dome for up to 12 hours following donation. This time window allows doctors to better assess the potential of the organs for transplant, or to repair damaged lungs. Today, only 25% of patients can find a lung donation match. Keeping the lungs alive for a longer period of time improves those odds, increasing lungs’ chances of being used by as much as 5 to 10 times.

In case you didn’t catch that, lungs are breathing in a glass dome. Creepy? You bet. Check it out yourself:


The lungs are kept alive at 37°C, the same temperature as your body. Vitrolife, an international biotech group, worked with Swedish doctor Stig Steen to develop a bloodless solution that allows the functionality of lungs to be tested prior to transplant. Called Steen Solution, the fluid is rich in nutrients, oxygen, proteins, and all that good stuff that keeps your lungs happy and healthy. By running the solution through the lungs, doctors can assess how well they exchange gasses, their ability to maintain normal body temperature, and a whole host of diagnostic criteria that take valuable time to assess.

Four* patients have received transplants using the technique to date, and all have been successful. Andy Dykstra was is the only successful recipient whose new lungs were unfit for transplant until the XVIVO system was used to repair them (the other three donations met criteria, but were further repaired prior to surgery). Andy could breathe without artificial help just four days following the transplant, and was discharged from the hospital after only twelve days. Not too shabby for a complete lung switch-out.

Dr. Shaf Keshavjee, Director of the Lung Transplant Program in Toronto, put the technique in context: “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.”

Individuals with cystic fibrosis and emphysema are often at risk of lung failure during the later stages of their disease. But finding a new pair of lungs is no easy feat. Normally, lungs are cooled after donation to preserve the organs prior to transplant. But the cooling process slows cellular metabolism, which inhibits active repair strategies before transplantation. Keeping them at body temperature allows more repair work to be done, improving the chances of a successful transplant.

With an active imagination, you can pretty much run wild with this one. Maybe someday, these technologies will find a use without the need for organ donation. Imagine receiving artificial respiration while your lungs were removed, repaired, and inserted back into your body. Think of it like a tune-up for your body. I, for one, would love to see a big room full of lung donations pumping away in little domes. Patients could pick their favorite transplant organ, sort of like choosing your lobster at a seafood restaurant. Well, okay… maybe not.

Regardless, this technique creates new options for lung repair and will drastically increase the success rate of donated lungs. All told, that’s pretty cool.

*As of June 4th eleven patients have received lungs that were repaired and reconditioned by the EXVIVO process.

You can find the press release about the XVIVO system here.

“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

Organ donation advocate and volunteer fondly remembered

BY Megan Doherty The Canberra Times

Andrew Bird was well known in Canberra for his strong advocacy of organ donation and his volunteer work with the YMCA.

But his cheeky sense of humor and spirit of life were what most people remembered about him.

Mr Bird, who would have turned 41 on December 28, died last month, just six months after receiving a double lung transplant at St Vincent's Hospital in Sydney.

The former bus driver suffered from coronary obstructive pulmonary disease, which he developed in the past three years, and which was partly related to emphysema.

His parents, Noreen and Des Bird, of Farrer, cared for their son in his final years. Family and friends gathered at Andrew's funeral in Canberra earlier this month after his death on November 27.

"I was there when he took his first breath and there when he took his last," Mrs Bird said.

Andrew, who volunteered with the YMCA, at its community gym at Chifley among other places, was "a great jokester" who tried never to let his illness affect his positive outlook.

"He always had a job, he always looked on the bright side of life, always had girlfriends, and in the last three years of his life he became very proactive in promoting organ donor awareness," she said.

He had been a moderate smoker and gave up as soon as his condition became known. He was on an oxygen tank 24 hours a day until his transplant.

"I don't advocate anyone putting a cigarette in their mouth and Andrew should have been one who never did," Mrs Bird said.

When he received his double lung transplant in May, Mr Bird was able to breathe on his own. He could play his beloved lawn bowls at Yamba Sports Club unencumbered by his oxygen tank. He believed he had a second chance at life.

"He was really good in the first little while. He was playing sport. He tried to ride a bike and put on weight and was looking well," Mrs Bird said.

"Then bells started to ring that things weren't quite right. His transplant team was really devastated because an extremely low percentage of people have complications in their first 12 months of receiving an organ and it happened to him. They worked so hard for him. And he fought so hard."

Mr Bird couldn't donate his own organs because of the medical drugs he had to take but he was always grateful to his donor.

Mr Bird Sr rang Ian "Macca" McNamara on ABC Radio's Australia All Over yesterday to let him know about Andrew's death and to thank the St Vincent's transplant team. Andrew had been a regular caller to Macca.

"He had a bloody go," Mr Bird said.

Among those to offer the Birds their condolences was Chief Minister Jon Stanhope, who wrote a letter of sympathy on behalf of his Government and "the people of Canberra".

“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

Transplant hopes dashed by 'false alarms'

When I read that Brian Maloney had eleven false alarms for his lung transplant I was incredulous. I heard of one transplant patient having four calls to rush to the hospital for their transplant only to find the donor lungs were not suitable, but eleven false alarms is probably a world record. I have great empathy for Brian knowing how excited he must have been with each call only to have his hopes dashed. Hopefully the new Ex-vivo procedure described below will make lungs viable that would have been previously unsuitable.



By Amanda Crook Manchester Evening News

BRIAN Maloney desperately needs a lung transplant. But on each of the eleven times he's been summoned to hospital to prepare for the operation, he has been sent home without surgery.

Brian, 60, has been on the waiting list for a replacement lung for 15 months and every few weeks since then he has been called into hospital as doctors prepare and test donor organs.

But each time the lungs have been deemed unusable or they have both been given to someone waiting for a double transplant.

Doctors at Wythenshawe Hospital say they have never known a patient be so unlucky so many times.

Brian, of Bee Hive Green, Westhoughton, Bolton, needs oxygen to help him breathe 24 hours a day.

He said: "I desperately need a transplant now. Every time they call me in I have to prepare myself for the operation, it is impossible not to get your hopes up when it is the only option open to you.

"Mostly I've been called in at night and then have to wait - too excited and nervous to sleep - before being sent home in the morning.

"I am really pleased to have been called in for the operation because I know lots of people on the list die without ever being called in but it is tough," said Brian, who has decided to talk about his experiences to encourage more people to become donors. Mr Maloney's partner of six years, Hilary Grimshaw, said: "It is so traumatic preparing yourself for such a big operation and then going home without having it."

Surgeon Nizar Yonan said Mr Maloney's case illustrates the need for more people to donate relatives' organs.

He said: "We call in two or three people each time an organ becomes available because we want to ensure we use all suitable organs.

"We do always warn people we may not be able to carry out the procedure and often people will be called in a few times before having an operation but this is a very unusual case."

Mr Maloney, who suffers from the deadly condition pulmonary fibrosis, has signed up for a pioneering procedure which was tested at Wythenshawe last month.

Doctors now have the technology to use lungs from people who have not been kept alive by machines. Central to this is a new technique to test lungs 'ex-vivo' - outside the body - to check they are suitable for transplantation.

To find out more about organ donation and register as a donor call: 0845 60 60 400 or go to UK Transplant.

“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

Australian lung transplant recipient overcomes perplexing infection

Bendigo's miracle man: I could feel bug biting me

bendigoadvertiser.com.au

NEIL Gibson doesn’t mind having a joke about his new body image.
But when you look into his eyes, you know . . . this man has been to hell and back.

“I was nearly dead,’’ he said.

“Twice.’’

In a strange twist of fate, it was the first near-death experience that actually saved Neil from dying from the second.

After battling emphysema, Neil was in critical care in Bendigo with only days to live when the life-saving call came through.

A suitable lung donor had been found.

The call came at 2am on one of the few occasions Neil’s wife Glenis had left his bedside to go home for a rest.

When the hospital phoned, Glenis thought it was the call she had been dreading.

But by 12.30pm the same day, Neil was in theatre receiving a double lung transplant.

He left hospital three weeks later and stayed in a unit near the hospital for three months for ongoing treatment.

But a month after the transplant, pus started oozing from Neil’s wound.

Tests to determine the cause were inconclusive and antibiotics were having little effect.

Surgeons took three biopsies before putting Neil under the knife a fourth time.

This time, they removed flesh, skin and much of the left side of his chest.

The following day, Neil was again rushed to surgery because the bug was still in his body.

Skin grafts were taken from his leg to repair the damage.

“It was killing me,’’ Neil said.

“It was eating me . . . I could feel it biting me.

“They didn’t know what to treat it with, they knew nothing about the bug.’’

The biopsy was sent to Sweden, then America and on to Vancouver on Canada’s west coast before two drugs used for treating leprosy were imported from Sweden.

The bug was identified as mycobacterium abscessus, a rapidly growing mycobacteria that causes cutaneous and respiratory infections.

It’s believed Neil had the bug in his system after using potting mix in the garden.

Treatment for the bug is complex and the goal is often control rather than cure.

The drugs imported to treat Neil were designed to poison the mycobacteria, but the result was five months of hell.

“They were keeping me at a level not to kill me with the poison,’’ Neil said.

“But the drugs were worse than the lung operation.

“I was falling over, couldn’t walk, had no balance and couldn’t sit down.

“In the finish I didn’t want to live . . . I didn’t give up before the transplant, but on these drugs, I said `no, that’s it’.’’

After five months of treatment, Neil took himself off the medication.

To the surprise of his medical team, Neil improved and was soon well again.

“They call me the miracle man,’’ he said.

“I’m now mowing the lawn and back to gardening.

“Bu I’m bloody lucky.’’

Such is Neil’s appreciation for life and those who have helped him through the journey that he now volunteers at Chum House palliative care.

“They looked after me for two-and-a-half years,’’ he said.

Neil starts talking about how he feels to be helping those who are close to death . . . but quickly starts joking again.

“It can be a bit awkward,’’ he said.

His eyes told the rest of the story.

“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

Ex-vivo lung transplants are saving more lives

It's exciting to see that more transplant centers are starting to use the ex-vivo lung transplant technique. Presently only about one in five donor lungs turns out to be suitable for transplant but surgeons predict that the ex-vivo procedure will result in about three in five donor lungs being usable and save more lives by getting more people off the waiting lists.

Haverfordwest nurse part of pioneering operation

"Ex-Vivo lung assessment, improves the quality of donor lungs by pumping them with blood, gases and oxygen which keeps them healthy for longer than they would normally survive outside the body"

Western Telegraph - A nurse from Haverfordwest has found herself at the cutting edge of organ transplant technology following a pioneering lung operation in Manchester.

Working on the cardiothoracic intensive care unit at Wythenshawe Hospital, 26-year-old Suzy Woodhouse witnessed first hand the successful transplant of the UK’s first donor lungs made to breathe outside the body.

The groundbreaking technique, Ex-Vivo lung assessment, improves the quality of donor lungs by pumping them with blood, gases and oxygen which keeps them healthy for longer than they would normally survive outside the body.

It also means lungs that would have been rejected can be optimised so they are of a higher quality for transplant.

The breakthrough means many more organs could become available for transplant and reduce the number of people on the transplant waiting list.

Wythenshawe Hospital currently performs around 20 lung transplants a year and hopes to increase that by ten with the ex-vivo technology.

Suzy, who has been a cardiothoracic staff nurse for more than a year and worked at Wythenshawe Hospital for around three years, helped care for the recipient of the first ex-vivo lungs, Ken Collins, as he recovered from the major surgery.

Suzy said: “We saw the lungs in the theatre in a sterile field as they were being ventilated so they looked like they were breathing which was very strange.

“It is exciting technology. So many people die on the waiting list but now more people will be able to get transplants and will be less sick when they get them.

“Ken is such a nice man, I helped to look after him in rehab and helped him get back on his feet, it is great to see him back to normal.”

“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