Eva Ottosson wants to give her daughter the give of motherhood.

Throughout her early childhood Sara Ottosson appeared perfectly healthy. It was only when she reached her teenage years and failed to menstruate that they suspected something was wrong. It turned out that Sara had a disease called Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome: even though she looked perfectly normal, her reproductive organs had failed to develop. She was born without a uterus. The cause of MRKH syndrome is not known, although it is suspected to result from a combination of genetic and environmental factors. It affects approximately 1 in 4,500 newborn girls worldwide.

Led by Dr. Mats Brännström, a team of surgeons at the University of Gothenburg in Sweden are giving Sara, now 25-years old, hope that she may one day fulfill her dream of giving birth to a baby. The uterus will come from a very special donor: Eva Ottosson, Sara’s mother. Sara’s operation will mark only the second time transplantation of a uterus has been attempted in humans, and the first time between a mother and daughter.

The only previous attempt was performed in 2002 by surgeons in Saudi Arabia. The uterus from a 46-year-old woman was transplanted into a 26-year-old woman after the younger woman hemorrhaged following childbirth. She still wished to have another baby. The transplanted uterus stayed healthy for a while, but eventually developed blood clots that cut off blood flow to the uterus. It was removed after 99 days. The transplanted uterus was meant to be temporary, to be removed following childbirth. Immunosuppressant drugs that the 26-year-old had to take to prevent rejection of the donated uterus could cause serious side effects.

Following the initial operation, experts in the field asked if it was ethical to subject a patient to the risks of a transplant if the organ is not lifesaving. Members of the country’s medical community commented that uterus transplants would be particularly useful in Saudi and other Muslim countries where using surrogate mothers is prohibited by Islamic law.

So too in Sweden are surrogate mothers illegal. And as far as Sara is concerned, the chance to give birth to a child is worth the risk of the operation. Speaking with The Telegraph, she said, “It would mean the world to me for this to work and to have children. At the moment I am trying not to get my hopes up so that I am not disappointed. But we have also been thinking about adoption for a long time and if the transplant fails then we will try to adopt.” Eva talks about giving her daughter the chance at motherhood in the following video.

When confronted with the inevitable question of what it will be like to recieve the same womb from which she was born, the 25-year-old invokes austere scientific logic: “I haven’t really thought about that. I’m a biology teacher and it’s just an organ like any other organ,” she told The Telegraph. “But my mum did ask me about this. She said ‘isn’t it weird?’ And my answer is no. I’m more worried that my mum is going to have a big operation.”

Both Sara and her mom have reason to worry.

According to Dr. Brännström, transplanting a uterus is more difficult than transplanting a kidney or liver–it’s even more difficult than transplanting a heart. The uterus needs more blood than those other organs to function. Thus, the amount of blood vessels that need to be connected to the uterus is greater. Dr. Brännström also cites the uterus’s inconvenient anatomical location. He likens working deep within the pelvis to “working in a funnel.”

Even more worrisome than making sure all the blood vessels are in place and working, the unprecedented nature of human uterus transplants means a standard immunological strategy has not been worked out. As with all transplant operations, a major risk is that the host’s immune system will reject the donor organ. To minimize rejection, hosts are routinely given immunosuppresive drugs. But, as Brännström and colleagues reported in a recent paper, human data is extremely limited: “A handful of studies on immunosuppression to prevent rejection after uterus transplantation have been published. However, no treatment protocol, successful in terms of long-term survival and functionality of the graft, has been presented. It is obvious that detailed studies addressing this issue and high success rates are needed before another human uterus transplantation attempt.”

The paper was published in November of 2009. I’m rather skeptical that a whole lot of “detailed studies” with “high success rates” have been reported since its publication.

But the uterus becomes a whole new bag of marbles once it’s pregnant. During pregnancy, the uterus activates a physiological program that makes it more tolerated by the host. This is where Sara’s boyfriend comes in.

As soon as the new uterus has healed, the doctors are going to take sperm from Sara’s boyfriend and try to impregnate her with it. The sooner she gets pregnant, the better chance she has of avoiding complications due to rejection.

Dr. Brännström and his colleages–as well as Sara and Eva Ottosson–stand at a precipice that is half a century in the making. In the time since the initial experiments began in the sixties, researchers have successfully transplanted wombs among rats, mice, dogs, pigs, sheep, rabbits, non-human primates, and–for 99 days–between two humans. So many unknowns will follow Sara and her mother into the operating room when they undergo the surgeries next year. So much trust will they be putting into science and into the hands of their surgeons. For their sake, and for the sake of all women hoping to undergo the same procedure, I hope that trust is well-placed.

[image credit: dailyrecord.co.uk]
[video credit: Newsy.com via YouTube]
image: dailyrecord
video: Newsy

A team of international surgeons transplanted a new larynx (voice box) into a California woman, this is only the second such case recorded.

After eleven years, Brenda Jensen is finally able to speak with her own voice, but she’s using someone else’s larynx to do it. Over a two day period in October at the UC Davis Medical Center, nearly two dozen medical professionals worked to transplant a larynx (voice box), thyroid, and trachea into Jensen. The 52 year old woman had damaged her own larynx after repeatedly pulling out a breathing tube during a hospital stay eleven years prior. She’s spent the last decade breathing through a tracheotomy tube and speaking with a handheld device that made her sound like a robot. Now, she feels human once again.  Her team of surgeons recently gave a press conference on her case. You can hear Brenda Jensen for yourself in the two news clips below. This remarkable surgery is just the latest example of how medicine will one day be able to replace or repair any part of your body.

Jensen’s 18 hour operation took place over two days and featured a dream team of doctors from the US and Europe. The delicate procedure required the surgical team to connect the implanted trachea, thyroid, and larynx to both the cardiovascular and nervous system – including five nerves, three arteries, and two veins. As remarkable as this highly precise surgery was, it was actually the second larynx transplant on record. The first was performed in 1998 on Tim Hiedler (aged 40) at the Cleveland Clinic. As with Hiedler, Jensen’s post-transplant voice is her own. A person’s unique sound is decided by the nose, throat, and mouth, not necessarily the vocal chords.

In the three months since her surgery, doctors report Jensen is doing well. According to UC Davis Medical Center, she will continue to breathe through the tracheotomy tube and eat through a feeding tube until her throat can be trained to swallow, inhale, and exhale properly. She may take considerable time to fully recover, but doctors believe that she will eventually be able to eat, drink, speak, and breathe normally. She’ll even be able to swim again, something Jensen has had to avoid (along with showers) for more than a decade.

What makes Jensen’s story so remarkable, besides her obvious joy at reclaiming her voice, is how rarely such transplants are attempted. Due to the nature of the replacement parts being donated from someone else, Jensen is required to be on immunosuppressants for the rest of her life. As she is already a kidney and pancreas transplant recipient, however, she was faced with such a regimen anyway. Also, in the last few decades, throat surgery has progressed such that many incidences of injury to the larynx can be fixed without a transplant. Improvements in chemotherapy have likewise reduced the prevalence of people who lose their voices due to throat cancer.

So is this surgery simply a fluke? A bizarre testament to the surgical advances of the past quarter century? No, it’s a bit more. During the complex and delicate operation, and over the long period of rehabilitation, Jensen’s transplant gives doctors a look into the workings of the human throat. The nerve connections, the blood vessel connections, the process for gaining control of the larynx – these provide new insights that will inspire other surgeries and techniques. According to Paolo Macchiarini, one of the surgeons involved, “Not only is it highly relevant for future transplants, it offers us insights that may one day lead to using stem cells to repair the voicebox and surrounding areas in the throat.”

When it comes to stem cells and the throat, Macchiarini knows what he’s talking about. Last year he was the leader of a team that grew a new trachea in a 10 year old boy using the child’s own stem cells. As he stated in regards to the Jensen case, “Being able to restore nerves and reconnect blood vessels in and around the larynx and trachea, and have it all work, was a real test.” Perhaps this most recent operation will lead to further remarkable work from Macchiarini in the near future.

Whether it incorporates stem cells, bionic devices, or animal spare parts, the future of surgery is going to become even more complex and far-ranging. We’ve already seen hand transplants, full face transplants, and dozens of other complicated procedures that would have seemed mythical had they been attempted fifty years earlier. Some progress will come from improved surgical instruments (including robots), some will arise from improved knowledge of cells, but much of it could still come from simple human ingenuity. The opportunities for ground-breaking transplants such as this one may be rare, but they will provide the fuel for many more medical innovations in the future. Congratulations on your restored voice Ms. Jensen, and best wishes to everyone on this project.

[image credits: UC Davis Medical Center]
[video credits: CBS News, ABC News]
[sources: UC Davis Medical Center, ABC News]

This transplant was grown using stem cells and a scaffold derived from a trachea.

Two very different organ transplant stories highlight the amazing skills of surgeons, and the importance of stem cells for the future of surgery. Both transplants involved the trachea, women, and operations in Europe. In the first, Claudia Castillo had a donor’s trachea covered in her own stem cells so that it could be transplanted into her chest as the left bronchus. The second transplant gave Linda de Croock a new trachea by first letting the donor organ acclimate to her body in her arm for ten months. The stem cell treatment was performed by doctors at the University of Bristol (UK) and the Hospital Clinic of Barcelona (Spain) in 2008. The trachea-in-arm treatment was performed at the University Hospital of Leuven (Belgium) and was recently discussed in the New England Journal of Medicine. Comparing these two operations demonstrates the phenomenal capabilities of modern medicine, and shows that stem cells enhance those capabilities in remarkable ways.

Excuse me, is your arm coughing?

Linda de Croock, now 54, lived for 25 years with metal stints in her throat to keep her windpipe open. Her own trachea had been crushed in a tragic car accident. According to her conversations with journalists the stints were horribly painful, affected her ability to communicate, and lowered her quality of life. She sought out Dr. Pierre Delaere, whom she discovered via the internet, and who had performed impressive transplants for cancer patients. The concept that Delaere and his colleagues developed was simple: to reduce the chance of rejecting a donor trachea, they would first wrap the organ in de Croock’s own cheek cells and acclimate it to her body by resting it in her arm.

Similar work had been done for many other organs, including using the muscle tissue of the back to prepare parts of a jaw. Yet this trachea-in-arm maneuver would be the largest organ to ever undergo such treatment. de Croock kept the trachea in her arm for ten months, with layers of plaster around the limb to keep it safe. She also was kept on a steady regimen of immunosuppressants to prevent rejection. After four months, mucous was growing healthily on the organ. Nearer the ten month mark, suppression therapy stopped and the organ remained healthy. Eventually, the chimeric trachea was transplanted into the throat. Once there, no further immunosuppression therapy was needed.

Linda’s new trachea is doing well. She can speak much more easily now, and her breathing is normal. Because she doesn’t require any further suppression therapy, she is not as vulnerable to illness, nor runs the increased risk of cancer associated with those medicines. Doctors were so pleased with de Croock’s results that they performed the same surgery on an eighteen year old male and have two more patients in queue.

I would just like everyone to digest that for a moment. Doctors wrapped a dead man’s trachea in cheek tissue, stored it in an arm, and got it to successfully transplant into a throat. Not once, but twice. And they’re going to keep doing it, presumably with great success. Science and modern medicine blow my mind.

I’ll be back in a few weeks… with a new organ

Tuberculosis lead to Castillo's left bronchus becoming dangerously narrow. Doctors would build her a transplant using a donated trachea and her own stem cells.

Tuberculosis damaged Claudia Castillo’s lungs and airways. The Colombian mother had such trouble breathing that she was often unable to play with her children or climb stairs. Her left bronchus was narrowing dangerously and some sort of surgery was needed. That’s where Professor Paolo Macchiarini in Barcelona and Professor Martin Birchall in Bristol stepped in. Previous work with pigs had shown that an organ could be stripped down using enzymes and other chemicals. This would leave the organ as nothing but a scaffold. Stem cells could be applied to this scaffold and encouraged to regrow the organ. Singularity hub has discussed similar work done with rat and pig hearts.

Macchiarini and Birchall were willing to try the procedure with Castillo and a donor trachea. The trachea was stripped down into a scaffold. Castillo’s stem cells were harvested from her leg bone marrow, and non-stem cells were taken from her throat. Birchall used these cells in a bioreactor in Bristol to regrow the scaffold in Bristol. In just four days, the organ was complete and because Castillo’s cells were used in the process, it would be recognized by her body and not rejected. Macchiarini then performed the operation to replace her damaged left bronchus with the new stem cell trachea.

Four days after that surgery, the team found that the new organ was virtually indistinguishable from the rest of Castillo’s body. After a month, tests proved that the transplanted trachea had developed it’s own blood supply – it was a viable part of her system. Four months after her treatment, Castillo’s ability to breathe showed great signs of improvement: she could climb two flights of stairs and take care of her children.

Again, a moment. Doctors used a stem cell technique to grow a (partially) new bronchial tube that was recognized as part of the patient’s own body. It only took a few days for that tissue to be assimilated and a few months for that assimilation to be (essentially) complete. My mind is blown. Again.

I’ll have what she’s having

If you need an experimental organ transplant, I’m sure that both of these stories are promising and uplifting. Yet I don’t think it’s disrespectful to the work done in Belgium to say that I would greatly, greatly prefer the stem cell treatment option. Who wouldn’t. It took four days to grow a new organ on a scaffold. Four more days before doctors were amazed at the organ’s acceptance after surgery. Jump ahead four months and Castillo is playing with her kids and climbing stairs (probably not at the same time, as that’s dangerous, but still). If these two procedures had been started at the same time Castillo would be mostly finished while de Croock still had months left incubating a trachea in her plastered arm. From a patient point of view, there’s almost no comparison to these two procedures.

Yet the Belgian team is moving forward quickly, racking up successes while, according to BBC News, the British/Spanish team hopes for clinical trials in similar cases to start by around 2013.

The discrepancy between the two stories isn’t caused by stem cell controversy. There’s no political hold up, and there’s not a lack of funding. No private interest groups are fighting over intellectual property rights. None of the commonly debated impediments are keeping us from enjoying this new and promising surgery.

It’s just science. The trachea-in-arm technique may seem like it came from the mind of Dr. Frankenstein, but it is a lab tested, hospital approved, and proven means of prepping organs for transplants. There are years of clinical trials and human lives saved behind this technique. Admittedly the size of the trachea is formidable, and larger than previous organs, but it’s the same basic idea. Stem cells scaffolding for whole organs is still relatively new. It’s mostly in the lab phase. There has to be years of steady tests and experimental procedures like this one before doctors are certain that it’s a good treatment for patients.

But that’s also the really hopeful part about the Castillo transplant. The only thing standing in its way is the regular (and necessary) progression of science. All signs point to the scaffolding technology as developing into a very successful alternative/compliment to organ transplants. Scaffolding for bladders and simple tissues are proceeding very well in the United States, moving into Phase III of trials. As they move forward, so too will more complex organs like tracheas, and hearts. Give medicine a decade, and such techniques may be the norm. In the meantime, the high quality and inventiveness of surgeons will produce techniques like the de Croock transplant. Some of those techniques will live on as stem cells aren’t always an option for treatment. It’s a win-win. Frankenstein for now, stem cells in the near future. Medicine is cool.

[photo credits: BBC News]

Kay Thornton became the first US patient to have her vision restored with the help of a tooth transplanted in her eye.

When you are blind and trying to restore your sight, you’ll try anything. I mean, anything. US doctors have recently returned a woman’s vision by using a transplanted tooth to help anchor a telescope in her eye. That’s right, a tooth. The procedure took several surgeries at Bascom Palmer Eye Institute in Miami, but it has given Kay Thornton her vision back after nine years of blindness. Check out the clip from NBC Today Show (via Hulu) after the break, apologies for the commercial.

Part of what is remarkable about this surgery is that it’s actually more than 40 years old. Modified osteo-odonto keratoprosthesis (MOOKP) was developed in Italy in the 1960s. It’s been performed around 600 times worldwide, but Thornton is the first US patient. Unlike corneal transplants, MOOKP does not require donor matching as all the tissue comes from the patient herself.

Unlike the other telescope implants we’ve discussed, the MOOKP telescope is simply correcting corneal damage. The rest of the eye is healthy. In Ms. Thornton’s case, the cornea was scarred due to lack of moisture stemming from Stevens-Johnson syndrome.

As described in the video, the MOOKP procedure takes place in several parts. First, a tooth and section of the jaw is removed and filed down to hold the telescope. The assembly is planted under the skin for a period and a skin graft from the cheek is placed over the eye. This step allows the tooth bone to bind to the telescope, and for the skin graft to keep the eye moist.

The tooth is then extracted and placed on the eye (allowing the telescope to pass light onto the retina) and the skin graft covers the eye again to keep everything lubricated. The graft can be further covered by a cosmetic shell (shown in the video diagram). It appears Thornton is not using a shell at this time as you can see the fleshy pink graft in some of the video.

MOOKP has never been used in the US due to its lack of testing and concerns over safety. Corneal transplants have taken its place for a majority of prospective patients. I’m not sure whether Thornton’s case is a special one, or if the Miami based surgical team will continue to perform the procedure. There seem to be few risks associated with the technique beyond tooth loss and the general risks assigned to corneal surgery.

Perhaps the big lesson here is that good surgeries never die. When a medical technique is extreme and strange, it has a low chance for widespread adoption. Still, if the procedure works, and it can’t be done in a different way, it will eventually develop a following. 600+ patients have tried to restore sight with the help of a tooth, and now that the US has a success to point to, that number could climb even higher. It makes you wonder what other procedures have waited 40 years to make it to the US, or the world,  and how we might be benefit if they saw wider use.

The Abiocor artificial heart

The artificial heart has come a long way since its first clinical use in the 1960’s.  Wireless technology and an internal microprocessor make the AbioCor better than its predecessors.  The entire system is implanted during a procedure where the diseased heart is cut out and the arteries are clamped onto the thoracic unit.  Wires are laid in the body down to the abdomen, where the controller and battery are implanted.  Wires then connect the controller to a receiver planted in the chest called the TET, or Transcutaneous Energy Transfer.  Wearing a similar device on the outside of the skin allows for an external battery to power the system without having wires breaking through the patients skin.

The internal battery allows the patient more mobility, as the external power source can disconnected for up to 45 minutes as the patient bathes or conducts other activities of that nature.  Being hooked up to the power isn’t that bad either, as a fanny-pack portable battery system can provide up to four hours of continuous juice before needing to be recharged.  Despite all these seemingly beneficial quality of life improvements, there are still some drawbacks.

Battery life may seem to be a problem, but that may be easily overcome as battery technology evolves.  The main issue with the AbioCor system is its size.  Weighing in at around two pounds and taking up the space of about two hearts, the system is too big to fit in many people’s chest cavities.  Researchers have duly noted this problem and are currently working on a smaller version that will fit into more people and even some children.

An even bigger challenge to researchers is the longevity of the system.  The longest time a patient has survived on the AbioCor system is about 17 months from the time of implantation (not a very appetizing prospect for potential recipients), and in that time the system operated perfectly.  Doctors, however, are worried that the system can only last about 2 to 5 years before the plastic and metal components wear out and require additional surgery to replace them.

Barney Clark endured 112 days on the Jarvik-7

Comparing such a nearly sublime quality of life given by the AbioCor system to the artificial heart technology of even a decade ago would make any human cringe.  The most famous artificial heart, the Jarvik-7, was first used in 1982 and did not boast any sort of internal battery system.  Instead, two tubes were permanently implanted in the patient that allowed hydraulic fluid to pass in and out of the body to an external pump.  This meant that the patient had nearly no mobility.  Even worse was the constant pulsing of hydraulic fluid that was known to cause patients to be physically jolted every time the heart pumped.

So today’s artificial hearts are much better than they were before, right?  Right.  But all the anal-retentive scientists and doctors out there (House M.D. not included) know that the system can still be so much better.  There are still a lot of complications that can occur with the system that cause limited post-implant life span such as infections and strokes.  Researchers are working on these potentially deadly problems to help increase the life expectancy of patients with the AbioCor system but, even if longevity is increased, patients still have to look forward to another surgery to replace the mechanically compromised artificial heart after 2 to 5 years.  Yes, life expectancy must be increased before the artificial heart replaces the donated heart in most patients faced with the option, but the mechanical integrity of the device must also be increased so that it is capable of lasting longer than the patient ever could.  Only then will artificial hearts beat the donated hearts.  Until then, our money is on motorcyclists and skateboarders.

Insert heart here

You’ve heard a bit about heart transplants and they’re no piece of cake, but now there’s a company out there trying to make it a little bit easier. It’s not an off-color SNL skit, but it is a heart in a box. TransMedics Incorporated has designed a system that allows doctors to transplant still-beating hearts up to 12 hours after they are removed from the donor (compared to the standard 4 to 6 allowed by current technology where they freeze the heart). Yup. Scientists have invented a box that keeps the heart beating outside of the body. Holy crap!

This Massachusetts based company has raised $27.6 million in series B funding. Their proprietary machine pumps warm, nutrient-rich oxygenated blood through the donor heart until it is ready for transplant. The heart is kept in a sterile compartment that simulates the conditions within the human body, allowing it to function normally while outside the body. Along with the life-support systems, the TransMedics machine also has the capabilities for performing the necessary diagnostics that doctors require before the heart is transplanted through the use of a wireless monitor. Take a look at the video and prepare to… woah.

Doctors are impressed by the machine because, well, it works. There is no swelling of the organ or damage over the 12 hour residence time in the machine. The extended timeframe for transplant means that more suitable organs will be able to make it to their patients before time runs out and the organ dies. This could turn relatively unsuitable donors into prime candidates and reduce the number of patients on waiting lists across the country.

The TransMedics machine has already been cleared for widespread marketing in the European Union, but is still enduring clinical trials here in the United States. So expect to see this technology in the operating room relatively soon. Of course, we here at the Hub would never wish you the unfortunate circumstance to have a few pounds of flesh cut out of the center of your chest cavity, but if it just so happens to be the way life deals the cards and they wheel in one of these bad boys, know that you’re in safe hands. Well, unless your surgeon has narcolepsy. But that’s a relatively rare disease. You’ll be fine.

Where can it go from here? Humanity has certainly not reached the peak of heart transplant technology. Is 12 hours really enough time to get from donor to prepped patient? Probably not. It’s a sure step up from the 4-6 hours offered by current technologies, but it would certainly be a better situation to have a raft of waiting organs rather than a list of waiting patients. Perhaps one day the technology will exist to keep hearts beating and healthy outside of the body indefinitely, making for the immediate availability of donated organs when they are needed.

We have featured a few stories here on Singularity Hub about growing organs in the laboratory and perhaps this new way of keeping organs alive could be mated to these lab-grown organs. No, we’re not talking about a dystopian future where every family will have an organ room in their house with spare parts hooked up to these TransMedics machines just in case somebody has an organ failure. It could be a world where when an organ is needed, it is grown from the patient’s own cells and placed in one of these devices for safe, reliable and healthy transport from lab to patient. Though such a time is just over the horizon, we must now make due with harvesting our organs from dead people. At least we have a cool way of keeping those organs alive. Kali Ma!!!!

Kepner's surgery underway. Photo courtesy of University of Pittsburgh Medical Center

Kepner, a 57-year-old pastry chef living in Georgia, got his new hands after a nine-hour surgery at the University of Pittsburgh Medical Center. He is still recovering, but has strong circulation in both hands and has showed no signs of organ rejection. The success of his surgery is in part due to a unique new procedure to improve an organ’s chance of being accepted by the body.

Whenever an organ transplant takes place, doctors have to suppress the recipient’s immune system so that it does not reject the new organ outright. This suppression requires toxic drugs that can increase the chances of infection, cancer, diabetes, or other complications. But in the past decade, an innovative procedure has been used to reduce the need for such drugs while still minimizing the likelihood of rejection. Used during Kepner’s transplant, the procedure transplants stems cells from bone marrow into the donated organs, helping the immune system more quickly recognize the hands as part of the body.

Kepner has a long road ahead of him. He’ll need extensive physical therapy before he can use his new hands effectively. This is because when limbs are lost, the areas of the brain responsible for their control get shifted on to other functions. But there’s good news: doctors have recently shown that by reconnecting the nerves to the hands, the motor cortex recognizes their presence and can regain control. It’s not exactly plug-and-play, but the plasticity of the brain will improve Kepner’s ability to use his new hands over time.

The donated hands came from 23-year-old Jeff Keen, who died in an unspecified accident. As an organ donor, Keen’s liver, kidneys, heart, and one lung have already found new homes in five different recipients. Not only that, but his hand donation has made medical history. This was the first double hand donation in the US, and the ninth worldwide. Even single hand transplants are a pretty rare and recent procedure, with the first successful case in the US taking place in 1999 (there have only been six since). It’s an amazing thing how far organ transplants have come, and hard to imagine the future benefits they might still have in store.

Kepner signing up for his upcoming transplant

As we’ve reported in the past, prosthetic technologies are constantly getting better and better. Soon, a prosthetic limb could respond directly to the motor-sensory cortex, providing the same feeling and control as a natural limb. The day will soon come that prosthetics will be so well designed and integrated into the body that many folks will prefer them to natural limbs. But for many people, even a fully functional prosthetic could never replace the real thing, psychologically speaking. Procedures like these transplants show the amazing strides we’re taking to improve the quality of life for amputees.

Our ability to grow new organs in a laboratory setting has increased by leaps and bounds in recent years. Soon, you’ll even be able to custom-order an organ from the company Tengion.  At some point in the near future, growing a new hand might be a real possibility, cutting out the need for transplants between individuals and all the risks of rejection that come with.

But until these practices become safe and widespread, organ donation will continue to prove itself a public good, especially as our ability to perform successful transplants continues to increase. Unless you’re an Egyptian pagan, you probably won’t need your organs after the lights go out. So right now, look down at your hands, and imagine them making pastries with their new owner long after you’re dead. Isn’t that kinda cool?

So what’s it say on your driver’s license?

Lung tissue attached to the XVIVO system

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.

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