BY KEITH GEREIN, EDMONTON JOURNAL JUNE 26, 2013
EDMONTON – Edmonton has become the country’s first home of a revolutionary organ-transplant technology that holds the potential to save a long list of patients needing new lungs.
The ex-vivo lung perfusion device, commonly known as “lungs in a box,” is a portable unit that gives surgeons a vastly enhanced ability to transport and repair organs outside the body for up to 12 hours before they are transplanted.
“We can go to Halifax, we can go to Hawaii now to procure organs,” said Dr. Jayan Nagendran, director of research for cardiac surgery at University Hospital and the Mazankowski Alberta Heart Institute.
“It’s a new technology that circulates blood and breathes air into lungs outside of the body. And the blood is warm at 37 C as it would be inside the donor or recipient, so it really mimics the physiology the lungs are meant to be in.”
While other versions of ex-vivo technology are currently in use in Canada, Edmonton has the only one that’s portable. The 45-kilogram unit, which resembles a bar fridge, can be wheeled onto a plane and then taken straight to the donor’s bedside. Once the lungs are harvested and hooked up to the machine, the doctor can perform surgery on them to repair defects that would otherwise cause the organs to be dismissed as unsuitable for transplantation.
During the flight back, a wireless bluetooth component is activated that allows the doctor to adjust the blood flow and oxygen supply, keeping the organs at optimum health before they are implanted in the recipient in Edmonton.
That portability is an essential feature for Edmonton’s cardiothorasic transplant centre, which is the most geographically remote facility of its kind in the world, Nagendran said.
He said that of the 681 lung donations offered to the centre in the last five years, just over a quarter of them (183) were actually used.
Some were rejected because they were deemed in marginal condition, while others were too far away to retrieve using the conventional transport method of keeping the lungs on ice for up to eight hours.
The ex-vivo device is game changer for both those obstacles, Nagendran said. Since the unit can keep lungs in a healthy state for a longer period of time and since it allows doctors to repair defects, fewer donations will go to waste. That should mean reduced wait times and result in fewer deaths among patients awaiting a transplant, he said.
“We have unique challenges here in that we are often faced with extreme distances and flight times, and every minute, every hour the lungs are on ice, they are being damaged,” he said. “This (device) improves the quality of lungs prior to transplantation. Instead of using just one in four donations offered, we may have the opportunity to use much more than that, maybe up to half of the donations offered.”
There are typically about 75 patients awaiting a lung transplant in Edmonton, most of whom have to wait more than a year for their surgery because of a lack of suitable donor organs. Close to a third of the patients on the wait list die before receiving a transplant, but Nagendran believes all of those can be eliminated if the perfusion technology is used just twice a month.
The ex vivo machine was first put into action in early April.
Beaverlodge resident Joyce Werk, whose lungs were badly scarred with a condition known as pulmonary fibrosis, had been waiting since 2009 for a transplant when she finally got the call that a match had been found. Taken to hospital in Edmonton, she had little time to contemplate her place in history as the first Canadian to benefit from the transplant device.
“I said I was willing to try anything, I was in such bad shape,” said the retired receptionist, who needed heavy amounts of oxygen and got tired doing even small tasks.
While Werk, 66, was being prepped at University Hospital, Nagendran was travelling aboard a Learjet with device to the donor site.
The donor lungs were considered extremely marginal, rejected by other transplant programs in Canada and the United States. After attaching the lungs to the machine, the surgeon repaired perforations, drained excess fluid and made other improvements to make the organs more viable.
By the time they were taken back to Edmonton and implanted in Werk, they had been on the ex-vivo device for a world record time of 10-1/2 hours, Nagendran said.
“Because of her dire situation and our new technology, we chose to take a set of lungs that every other program turned down to use on someone who had no other options.”
Close to three months after the procedure, Werk said it has made a huge improvement in her quality of life. She is now off oxygen and expects to go home in a week.
“I’m still gaining strength. I’m walking around and doing odds and ends, going shopping. Within another three to four months, I should be back to my normal self,” she said. “It’s kind of mind-boggling. It’s nice to see the difference.”
The device was used successfully again in late April for Doug Hallett, 48, who is part of an international trial comparing the outcomes of lungs put on the device and those put on ice. Nagendran said he expects the perfusion technology will result in better survival rates and quicker recoveries.
“I felt a difference immediately,” Hallett said. “Eighteen days after surgery, I was out. I used to get winded doing up my running shoes, and now I can go on the treadmill 20 minutes or on the bike 20 minutes no problem.”
The device costs $250,000 but was donated by its manufacturer, U.S.-based TransMedics, which is leading the trial.
Major donations from the University Hospital Foundation and Alberta Transplant Institute help to cover the operational costs, which add up to about $45,000 each time the device is used.
Leaders at the transplant centre are hoping to get similar devices over the next few years to handle liver, kidney, pancreas and heart donations.
“I see this becoming the standard of care over time,” Nagendran said. “I would like to think that five or 10 years from now, we will look back and say, ‘I can’t believe I used to fly with set of lungs in an ice cooler on my lap.’ ” via Edmonton gets country’s first mobile lung-transplant machine.