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.
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.
