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From left, Michael Jaklitsch, Zain Khalpey and Phil Camp examine the lungs.
A multidisciplinary team breathed new life into a set of injured lungs after they were removed from a donor June 8—a process that has the potential to double the pool of lung donors and build upon BWH’s rich history of leadership in organ transplantation.
The BWH team is among the first in the country to take a set of human donor lungs not suitable for transplant and perform ex vivo perfusion, a way of reproducing the conditions of the human body and rehabilitating the lungs to the point they could be used for transplant.
“This process could revolutionize lung transplantation by increasing the number of available donors,” said Phil Camp, MD, director of the Lung Transplant Program, who worked closely with Thoracic Surgery’s Director of Clinical Laboratory Michael Jaklitsch, MD, and clinical cardiac fellow Zain Khalpey, MD. The team performed its second ex vivo case a week later on June 16.
BWH has about 30 patients on the waiting list for a lung transplant, and nationwide, more than 1,800 people are waiting for lungs, according to the United Network of Organ Sharing (UNOS).
Lungs are the most fickle of all organs, said Camp. The lungs are especially vulnerable, and it is difficult for surgeons to correct any issues while they remain in the donor without affecting other organs. As a result, only 15 to 20 percent of lungs removed from an organ donor are suitable for transplant, in contrast to 60 to 65 percent of livers.
The ex vivo perfusion allows time for surgeons to optimize the function of lungs outside of the body. The BWH team received IRB approval to do five such ex vivo cases. These lungs will not be transplanted. After completing these five cases, the team intends to begin using this new process to rehabilitate lungs that they would then transplant into patients.
“When BWH performed the first single and double lung transplants in New England in 1990, we had no conception of the possibility of an ex vivo lung circuit,” said David Sugarbaker, MD, chief of Thoracic Surgery. “We’re among the first in the country moving the science on this, and it represents a new step forward for lung transplantation in our region.”
Jaklitsch praised the research team at BWH. “Although several investigators around the world have worked on this concept, the BWH research team is unique in the amount of professional collaboration involved,” he said. “We have drawn on the fact that some of the best people in every field work here at Brigham, and this work has been advanced by surgical residents, cardiothoracic fellows, OR nurses, perfusionists, respiratory therapists, radiologists, pulmonologists, anesthesiologists, pathologists, thoracic surgeons and administration.”
Ex vivo perfusion requires incredible teamwork among surgeons, respiratory therapists, perfusionists and other clinicians, all of whom have been involved in practice runs for the first case.
During the procedure, perfusionist Michael Gilfeather and his team worked to warm the lungs and add carbon dioxide and remove oxygen from the blood.
“Essentially, we are mimicking the oxygen consumption and carbon dioxide production that happens in the human body during respiration,” he said. “The perfusion circuit we are using—which our whole perfusion team redesigned specifically for these cases—is acting as a surrogate for the human body.”
Christine Perino, RRT, and Paul Nuccio, MS, RRT, FAARC, of Respiratory Therapy, began ventilating the lungs. For six hours, the teams worked together to maintain pressure to prevent the lungs from collapsing.
“To be a part of this experience was quite amazing, and to think about the potential benefits for those patients who await a set of lungs for transplantation is somewhat overwhelming,” said Nuccio, director of Pulmonary Services, who has been in respiratory therapy for 30-plus years. “This experience certainly is a highlight of my career.”
The team will rehabilitate the lungs from a particular group of organ donors—those who experienced cardiac death. “For lungs, procurement from a DCD (donation after cardiac death) donor is sort of an unknown area,” Camp said. “This is especially important in our region because New England has among the highest rates of DCD donors in the country. We could potentially double the number of donor lungs.”