The lung transplant team at Baylor University Medical Center at Dallas (Baylor Dallas), part of Baylor Scott & White Health, is evaluating and testing two new preservation and transport technologies for donor lungs. The goal of both technologies is to improve the method by which organs are preserved after procurement until they get to the recipient.
The first technology is a revolutionary new organ preservation system that allows transplant programs to travel farther distances to procure donor lungs and provides the ability to better assess potential donor lungs that have borderline function. The only FDA approved device for both standard and expanded criteria donor lungs, the portable perfusion, ventilation and monitoring system maintains the lungs at a near-physiologic state.
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“This device is a combination of a heart-lung machine. The lungs are perfused with blood, oxygen and nutrients, and a ventilator pushes air through the lungs,” says Gary Schwartz, MD, Chief of Lung Transplantation and Thoracic Surgery, Baylor Dallas.
“The lungs are kept at a regular body temperature, and actually look alive outside of the body because they are breathing.”
In addition to expanded geographic retrieval range, the device is expected to improve outcomes compared to cold storage with a 50 percent reduction in primary graft dysfunction. According to its manufacturer, the longest registered transport to date is from Hawaii to North Carolina.
In addition to expanded geographic retrieval range, the device is expected to improve outcomes compared to cold storage with a 50 percent reduction in primary graft dysfunction. According to its manufacturer, the longest registered transport to date is from Hawaii to North Carolina.
“This device could facilitate international transport down the road,” Dr. Schwartz says. “If there is a perfect donor-recipient match, you can preserve the organs and take them wherever you need to take them. The device also could change transplant surgery into elective surgery. Instead of 2 a.m., a transplant procedure could be scheduled at 7 a.m. when the whole team is fresh.”
Because the new organ preservation system is very expensive, Dr. Schwartz says it will be used judiciously on marginal or borderline donor lungs. The lungs can be put on the machine, and physicians can take blood samples, perform a bronchoscopy and other tests before deciding to use them in the recipient.
An innovative cold storage system
For decades, the standard preservation method for donor lungs and other organs has been to place the organ in preservation solution in a cooler with ice. However, temperatures that are too cold or too warm can result in damage to the organ. A new and innovative cold storage system is designed to take the guesswork out of the ice approach.
In this new system, donor lungs are placed inside a closed and sealed vault to maintain the shape of the lungs and prevent physical trauma during transport. The lungs rest on a tray with an embedded temperature probe that continuously measures the temperature of the preservation solution. The system is validated to maintain temperatures of donor lungs between 4-8° C for more than 44 hours. Real-time monitoring and data reporting is available via Bluetooth® and a smartphone app. Transplant physicians can receive a report in real time of the exact temperature – to the decimal point – at which the organ was maintained throughout the entire transport process.
“These digitally controlled coolers have only been used about 75 times in the country, so we are very early in the national experience,” Dr. Schwartz says. “This system is also not cheap, so we plan to limit it to donor lungs with longer transport times when preservation is most important. With both of these new preservation and transport systems, we hope to increase our volumes and improve quality by having better preserved organs and a more controlled process of getting donor organs to the recipient.”
