Donor organs kept viable for transplant longer

'Cold' Carriers to up travel time for transplant hearts

You cannot blame transplant surgeons for having high BP. After all, speeding in an ambulance across the city, removing a beating heart (or liver or lung) from a brain-dead patient, putting it in a box of saline and rushing back before the organ gets infected or stops beating... and then operating for 6-12 hours,  cannot be good for the nerves.

The heart transplant team at Global Health City may be able to breathe a little easier soon, when they procure new organ transportation cases that are equipped with cold perfusion technology. “Right now, the organs are carried in sterilized boxes with ice and saline, which keep the organ usable for up to four hours. But the battle against time is a constant worry,” said Dr R Ravi Kumar, senior interventional cardiologist at the hospital.

Despite its having the best organ transplant programme in the country, at least a 100 harvested organs go to waste every year, rued cardiologist Dr Nandkishore Kapadia at the inauguration of Global’s Heart Failure Clinic on Wednesday. Most of it is because the organ gets infected before it reaches the recipient.

In contrast, the cold perfusion boxes will keep feeding the heart cold nutrients that circulate inside the blood-pumping organ, allowing it to stay alive and fresh for longer. “Studies have indicated that these cases will be able to keep harvested cadaver hearts alive for up to nine hours,” he added about the boxes which have been procured at a cost of `60 lakh. (more than $100,000 U.S.)

While the additional time will make it easier for ambulance drivers who battle the city’s traffic every day, what it really does is open up the possibility of procuring organs from further south. “At the moment, we struggle to procure organs from Tiruchy, which is about three hours away through our ‘green corridor’. With the advantage of these boxes, we may be able to receive organs from places like Coimbatore soon,” said Dr Ravi.

Global’s Heart Failure Clinic brings together the whole gamut of heart services from elective surgeries to emergencies in one department and is among the few of its kind in the country.

Source: By Express News Service - CHENNAI

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"Breathing Lung" transplant performed at UCLA Medical Center

First U.S. breathing lung transplant performed in Ronald Reagan UCLA Medical Center

From: News Medical

First there was the "heart in a box," a revolutionary experimental technology that allows donor hearts to be delivered to transplant recipients warm and beating rather than frozen in an ice cooler.  

Now that same technology is being used to deliver "breathing lungs." 

The lung transplant team at Ronald Reagan UCLA Medical successfully performed the nation's first "breathing lung" transplant in mid-November. The patient, a 57-year-old who suffered from pulmonary fibrosis -- a disease in which the air sacs of the lungs are gradually replaced by scar tissue -- received two new lungs and is recuperating from the seven-hour surgery.  

The groundbreaking transplant involved an experimental organ-preservation device known as the Organ Care System (OCS), which keeps donor lungs functioning and "breathing" in a near-physiologic state outside the body during transport. The current standard involves transporting donor lungs in a non-functioning, non-breathing state inside an icebox.  

With the OCS, the lungs are removed from a donor's body and are placed in a high-tech OCS box, where they are immediately revived to a warm, breathing state and perfused with oxygen and a special solution supplemented with packed red-blood cells. The device also features monitors that display how the lungs are functioning during transport. 

"Organs were never meant to be frozen on ice," said Dr. Abbas Ardehali, a professor of cardiothoracic surgery and director of the heart and lung transplantation program at Ronald Reagan UCLA Medical Center. "Lungs are very sensitive and can easily be damaged during the donation process. The cold storage method does not allow for reconditioning of the lungs before transplantation, but this promising 'breathing lung' technology enables us to potentially improve the function of the donor lungs before they are placed in the recipient."  

UCLA is currently leading the U.S. arm of the international, multicenter phase 2 clinical INSPIRE study of the OCS, developed by medical device company TransMedics; Ardehali is the principal investigator for UCLA. The purpose of the trial is to compare donor lungs transported using the OCS technology with the standard icebox method. The INSPIRE trial is also underway at lung transplant centers in Europe, Australia and Canada and will enroll a total of 264 randomized patients. 

According to Ardehali, in addition to potentially improving donor-lung function, the technology could help transplant teams better assess donor lungs, since the organs can be tested in the device, over a longer period of time.

In addition, it could help expand the donor pool by allowing donor lungs to be safely transported across longer distances.

"For patients with end-stage lung disease, lung transplantation can dramatically improve the patient's symptoms and offer relief from severe shortness of breath," said Dr. David Ross, professor of medicine and medical director of UCLA's lung and heart-lung transplantation program and UCLA's pulmonary arterial hypertension and thromboendarterectomy program. "The 'breathing lung' technology could potentially make the transplantation process even better and improve the outcomes for patients suffering from lung disease."

The "breathing lung" device follows on the heels of TransMedics' "heart in a box" technology, which delivers donor hearts in a similar manner. The multi-center national study of the heart technology, also led by UCLA, is ongoing.

SOURCE University of California, Los Angeles (UCLA), Health Sciences

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Irish aeromedical center will not open on time

By MARY MINIHAN The Irish Times

AN AEROMEDICAL center proposed after Leitrim teenager Meadhbh McGivern missed out on a transplant operation in July will not be ready by the recommended date of today.

The Health Service Executive has confirmed the 24-hour National Aeromedical Co-ordination Centre was not yet in place, but “the work that the center will carry out is currently being done across two sites”.

The 14-year-old Leitrim girl returned to Ireland on Monday after a successful liver transplant at King’s College Hospital, London, last month.

A new system to co-ordinate the transfer of patients abroad for emergency medical procedures was put in place after opportunities to transport the teenager to London in time for a long-awaited operation in July were missed after communications blunders.

A report by the Health Information and Quality Authority (Hiqa), which found no individual or agency was in charge, recommended the establishment of an aeromedical center. It was due to have been set up by today.

A spokeswoman for the Health Service Executive said it and other parties involved, including the Defense Forces, Coast Guard and Crumlin children’s hospital, had worked “vigorously” since the publication of the Hiqa report to give effect to its recommendations.

“A good deal of progress has been made in relation to the implementation of the recommendations of the report. This is supported by the fact that a number of patients have been transferred successfully recently, including one last night,” she said.

“In relation specifically to the establishment of a 24-hour National Aeromedical Co-ordination Centre, the HSE can confirm that this is not yet in place but that the work that the center will carry out is currently being done across two sites.

“An oversight group comprised of all parties is now in place, processes have been established and are working well, and once staff are recruited we will proceed to the full establishment of the center,” she added.

Meanwhile, a Hiqa spokeswoman said it expected the center to be established within two months as set out in the recommendations of its inquiry.

Joe McGivern, father of the teenager, said he hoped the center would be operational very shortly. “I hope that the delay won’t be too lengthy. I’d like to think it would be up and running sooner rather than later,” he said.

Speaking from Our Lady’s Hospital for Sick Children in Crumlin, where his daughter is recuperating, Mr McGivern said: “Meadhbh is doing fine. She’s in good shape and that’s the important thing.”

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