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article image'Lungs in a Box' could breath new life into lung transplants

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By Tim Sandle     Sep 12, 2014 in Health
This is a major step forward from the standard method of preserving lungs being transported for transplant; the standard procedure requires lungs to remain frozen by placing them on ice.
The new technology is best described as "Lungs in a Box" and it is anticipated harnessing this innovation will make lung transplants more successful in the future. The possibilities for the technology do not stop here, as Dr. Mark Plunkett points out. The "implications of this technology are staggering,” he notes.
In looking at why "Lungs in a Box" is so groundbreaking, Dr. Plunkett explains that a contrast can be drawn with the mainstream practice for handling organs for transplant. The standard approach is to remove lungs from the deceased donor and then to put them on ice in a container, and hold them in this manner for the duration of their transport to the recipient.
A major problem with this process is that lungs are very sensitive and can easily be damaged during the donation process. Moreover, the cold-storage method does not allow for reconditioning of the lungs before transplantation. As a result, lung transplantation programs around the world face significant challenges in organ availability, patient outcomes, as well as the overall cost of patient care.
The new "Lungs in a Box" technology takes a completely different approach by allowing for the transport of human organs while, at the same time, keeping them in a near physiologic state (best described as “nearly alive”). The technology preserves the life of the lung and significantly increases the possibility of a successful transplant. The technology is called a "portable Organ Care System" (OCS).
With the OCS technology, lungs are removed from a donor's body and are then placed in a specialized box. Once in the box, the lungs are rapidly revived to a warm, breathing state and perfused with oxygen and a special solution supplemented with packed red-blood cells (the box continuously circulates blood and oxygen through the lung).
The box-device also features monitors that display how the lungs are functioning during transport, allowing allowing doctors and procurement specialists to monitor the lungs at all times. A further advantage is that the box is portable, thereby speeding up the transfer to the patient. Even without the portability, lungs placed in the OCS device last for longer compared with conventional oragn transport devices. Lungs on ice cannot survive for more than eight hours; however, with the “box,” lungs last longer and doctors have already transplanted lungs held after 12 hours. This extended timeframe means that the OCS can overcome major obstacles created by conventional transplant methods
It is for these key reasons that Dr. Mark Plunkett expects the technology to be well-received by medical professionals. "For any surgeon, whatever can give the patient the best chance for a long, healthy life after transplant has to be considered paramount,” he states.
The new technology follows another major advance in donor transplants that also delivers the required organ to the donor in a faster time and in a way that preserves the organ for longer. Known as "heart in a box", a technology also developed by TransMedics, it allows donor hearts to be delivered to transplant recipients as warm and beating organs rather than still and frozen.
The "Lungs in a Box" technology not only serves to preserve healthy lungs for the patient; the technology allows for imperfect lungs to be reconditioned by flushing them with nutrients and antibiotics. The advantage of this process is that it vastly increases the available donor pool so lungs that might have been considered unsuitable in the past can now be considered by doctors for patient use.
Such an invention is of social and medical importance since there is a far bigger demand for donated lungs than there is supply, according to the Organ Procurement and Transplantation Network (OPTN), which reports into the U.S. Department of Health and Human Services. We have seen how lung recipients have to find a close donor match to their own lungs in terms of size and blood type.
Dr. Plunkett explains the implication of applying “Lungs in a Box” might “hold the key to longer, more successful lives after lung transplants."
The effectiveness of the "Lung in a Box" technology was recently examined in a trial. The trial compared donor lungs transported using the technology with the standard icebox method. For the study, various international lung transplant centers in Europe, Australia and Canada participated, and the trial consisted of 264 randomized patients. An earlier pilot trial, published in the medical journal The Lancet, found that lungs can be safely preserved with the new technology, resulting in complete organ use and successful transplantation.
The "Lung in a Box" technology has proved successful in practice. The technology is commercially available in Europe and Australia and is in clinical use in leading medical centers. Clinical trials in the U.S. are expected to start soon. Under the status of an investigational device, UCLA surgeons were recently able to perform the first-ever breathing lung transplant in the U.S.
Such is the potential of the technology it will probably evolve beyond the preservation of hearts and lungs. According to Dr. Mark Plunkett: "TransMedics envision having all of organ transplantation one day performed using this box technology where you keep organs functioning and 'alive' during transport."
Although Dr. Plunkett stresses that "there is a lot more to learn", he is also optimistic about future developments. As he notes "the demand for this kind of technology isn't going to go away."
More about Lungs in a Box, lung transplants, Health care, Mark Plunkett
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