How an Experimental Process Brings More Donor Lungs to Life

A new way to address the donor lung shortage

There’s new hope for those with pulmonary fibrosis and other lung diseases who need a lung transplant. Doctors estimate that the number of lung transplants could rise by as much as 50 percent in coming years, thanks to a promising process called ex vivo lung perfusion, or EVLP, which can rejuvenate donor lungs.

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Surgeons perform about 2,000 lung transplants each year in the U.S. Many more patients are waiting for a transplant, but there are not enough usable donated lungs.

Doctors are hopeful that EVLP, which doctors in Canada and Europe use commonly, will change that.

How does EVLP work?

With EVLP, surgeons use a miniature heart-lung machine to pump fluids and oxygen into donated lungs to get them working well again.

This can reverse injury and revive organs that might originally have been unusable for various reasons. Sometimes, tissue can be overly spongy because of too much fluid. Other times, lungs may have bruising. Depending on the individual organs, the process of EVLP may make lungs like these viable in two to six hours.

Though still in the experimental stage in the U.S., EVLP is starting to gain traction here, say Kenneth McCurry, MD, cardiothoracic surgeon and Surgical Director of Cleveland Clinic’s Lung and Heart-Lung Transplantation Program.

The Food and Drug Administration approved one device in 2014 under a humanitarian device exemption. The manufacturer is now seeking full approval. Researchers are studying other EVLP methods and trials are underway, he says.

Studies have found no additional risks associated with EVLP (beyond the risks that come with lung transplants), says Marie Budev, DO, Medical Director of Cleveland Clinic’s lung transplant program.

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Donor lungs getting a closer look

Dr. McCurry says he has worked with three patients who received lungs rejuvenated through the EVLP process.

“More importantly we have transplanted 14 additional sets of lungs knowing that we had EVLP available as a backup,” he says.

This means they used lungs they would not have considered in the past, knowing that they could rejuvenate them with EVLP if necessary. In those 14 cases, the lungs were healthy enough for use without going through the process.

Obtaining donor organs is often costly and risky. Transplant centers typically assess them to determine viability before sending a surgical team (sometimes long distances) to pick them up.

Now that EVLP is available, transplant centers have lowered their criteria and are evaluating more donor lungs. Typically, only about 20 percent of lungs from donors are currently considered viable. But that number could greatly increase as doctors use EVLP more often.

“This is extremely exciting because it gives us lots of opportunities to help more patients and improve their quality of life,” Dr. McCurry says.

‘It all starts with the donor’

Many people seeking a lung transplant have pulmonary fibrosis, a progressive lung disease with no cure. Other transplant candidates may have cystic fibrosis or emphysema.

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Patients on the waiting list are typically in the latter stages of disease and do not have other complications. Some transplant centers have age limits, but others do not.

“We have transplanted patients who were well into their 70s at the time of transplantation,” Dr. McCurry says.

Dr. Budev says patients may hesitate when doctors ask if they would opt for a transplant that uses EVLP.

Some patients may say ‘No, I don’t want a refurbished lung,’ ” she says. “We explain that all transplant lungs have been used before, and EVLP will open up the donor pool for them and in some cases may improve the lungs they receive. Then they become very open to the idea.”

The technology and techniques continue to improve and EVLP will likely open things up further as it becomes more popular. But one aspect of the transplant process has not changed — the source of the life-saving organs.

“It all starts with the donor,” Dr. Budev says.

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