Machine to revive donor organs used in double lung transplantation in Britain

Surgeons have performed a double lung transplant using a new machine that revives donor organs and keeps them alive and breathing outside the human body. This operation marked the first time the machine had been used in Britain.

The groundbreaking device consists of a bubble-like chamber that contains a series of pumps and filters that repair, restore and revitalize the lungs before they are transplanted into patients.

By perfusing the lungs in the machine, doctors can evaluate the organs for transplant and, if necessary, rehabilitate them. It also takes them significantly more time than the traditional method of keeping lungs on ice, which can cause tissue damage.

Experts say the arrival of the machine could dramatically increase the number of lungs available for transplant on the NHS, potentially saving hundreds of lives a year. Daniel Evans-Smith, 49, was the first patient in Britain to benefit from the XPS system, made by Xvivo.

Before the operation at the Royal Papworth Hospital in Cambridge, Evans-Smith, an events manager, had developed chronic obstructive pulmonary disease (COPD), a condition that causes breathing difficulties and can worsen over time, limiting daily activities and sometimes use of oxygen is necessary. .

After receiving new lungs from a donor patient that were revived using the XPS system, he woke up to find that he no longer had COPD. “It’s amazing,” he said in an interview with The Guardian. “The difference is phenomenal.”

For more than fifty years, the typical method of preserving lungs before transplantation was to cool them to just above freezing, which slowed their metabolic processes. This extends the period in which they can be transplanted, albeit only briefly.

However, once cooled it is impossible to properly assess its quality. Because lung transplants are complex and life-changing operations, surgeons tend not to use organs of uncertain quality. It means that only one in five donated lungs worldwide is ultimately used.

By giving doctors more time to examine the lungs, the XPS system could result in fewer donor organs being wasted and more patients being called to undergo a transplant. Evans-Smith was on the waiting list for just nine days.

The Royal Papworth team that performed the first surgery with the XPS system in Britain used a technique called ex-vivo lung perfusion (EVLP).

EVLP is a technique widely used in Europe and the US, but not yet common in the UK. A small number of EVLP transplants have previously been carried out in Britain, largely limited to clinical trials or using different machines.

Since their success with Evans-Smith, surgeons have performed transplants on three more patients using the XPS system.

The machine mimics the environment of the human body, allowing the lungs to inflate and deflate normally. A special fluid maintains them and helps restore normal function, allowing them to be preserved and even improved. The lungs can be stored in this way for up to six hours.

If they perform well for at least three hours of testing, they are removed from the system, ready for transplant.

Evans-Smith was operated on by a multidisciplinary team led by consultant surgeons Marius Berman, Giuseppe Aresu and Pradeep Kaul. After rehabilitation in intensive care and then the surgical unit, he recently returned to Northampton to continue his recovery.

Berman, the surgical lead for transplantation at Royal Papworth, said: “We are very proud to have become the first UK hospital to use this machine for a clinical ex-vivo lung perfusion case, providing Daniel with suitable donor lungs. Without this innovation, he might still be waiting for a transplant today.”

The chairman of a national NHS lung advisory group, Jasvir Parmar, said the machine marks a significant change in doctors’ ability to evaluate and improve the quality of donated lungs.

“Once you get the lungs out of the body, you can improve their performance so that it is not just an assessment tool but also a therapeutic tool.”

NHS Blood and Transplant’s national medical director for organ and tissue donation and transplantation, Prof Derek Manas, said the machine could help reduce the waiting list for organ donors.

“With more than 200 people currently waiting for a lung transplant, this far outweighs the number of suitable donor organs. It is critical that we support innovation to increase the chances that these desperately ill patients get the call they are waiting for.

“We are grateful for the work to improve transplant technology and techniques, but most of all grateful for the patients and families who agree to save and improve lives through organ donation.”

Evans-Smith is now looking forward to further recovering his health over Christmas without the burden of COPD. “Before I struggled to walk up a hill or any distance without having to think about where I could stop and rest to catch my breath.

“Now I take maybe 7,000 steps a day, including going up and down hills, and I can take 3,000 steps without even taking a breath. It’s just amazing, isn’t it?”