New ‘Lungs in a Box’ System Poised to Boost Organ Transplants

Surgeons anticipate that a novel device capable of sustaining lungs outside the human body has the potential to “transform” the volume of individuals undergoing transplants. This significant advancement originated at Royal Papworth Hospital in Cambridgeshire, which was the inaugural institution in the UK to trial the XPS system. The apparatus, referred to as “lungs in a box,” replicates the functions of the human body, and surgeon Marius Berman stated it could elevate the quantity of transplants by 30%. Daniel Evans-Smith, a 49-year-old event manager residing in Northampton, became the initial patient to undergo a double lung transplant utilizing this system within the NHS, expressing that he was “immensely grateful”. Approximately 81% of donor lungs are deemed unsuitable for transplantation due to inflammation or suboptimal condition. This device enhances the viability of the organs by employing a ventilator to facilitate the inflation and deflation of the lungs. Additionally, a solution enriched with nutrients and oxygen is circulated through them. This methodology is known as ex vivo lung perfusion (EVLP). Its application allows for donor lungs previously categorized as “borderline” for transplantation to be reconditioned and utilized, rather than being discarded. The organs are maintained at body temperature for a duration of up to six hours. Funding for the one-year pilot program was provided by NHS England and the Royal Papworth charity. Prior to this, the machine’s application was limited to UK research trials. Prof Derek Manas, who serves as the NHS blood and transplant medical director, indicated that there was “mounting evidence” suggesting this technology could “enable more transplants by improving organ function”. The hospital reported a scarcity of donated lungs, even following the 2019 legal amendment regarding organ donation consent, thus the machine was maximizing the utility of available organs. Prof Manas also stated that over 200 individuals were awaiting a lung transplant, a figure that “significantly” exceeded the supply of appropriate donor organs. Maintaining the lungs “alive” externally also grants surgeons the opportunity to assess the organs, thereby increasing the likelihood of successful transplants. Mr Evans-Smith ceased smoking 12 years prior, yet he subsequently developed chronic obstructive pulmonary disease (COPD), a respiratory ailment characterized by breathing difficulties. He experienced a collapsed lung five times and accumulated six months of hospitalization prior to his transplant. As he was nearing discharge, nurses awakened him to inform him that donor lungs had become available. The organs were chilled and transported to Cambridge, where they were then positioned within the machine for “reconditioning” in advance of the transplant procedure. Mr Evans-Smith remarked that it was a “privilege to be chosen”. He recounted: “There were conversations this time last year, with some of the hospitals saying I needed to talk about palliative care, because if I didn’t get the transplant under way very soon, the likelihood was I wouldn’t survive.” He now intends to initiate fundraising efforts for the medical team responsible for saving his life. “I can now do hills without having to think about it, I don’t have to rest when I’m out and about around town,” he stated. “I can’t thank them enough”. Marius Berman, the surgical lead for transplantation at Royal Papworth Hospital, expressed that they were “very proud to have become the first UK hospital to use this machine” beyond the scope of clinical trials. While alternative technologies are available, surgeons noted that the machine’s straightforward design facilitates rapid training, whereas certain other options necessitate a surgical team’s travel to the donor site, potentially incurring significant costs. He further mentioned that 30% of individuals awaiting a lung transplant succumbed, and Mr Evans-Smith had “had a very small window of opportunity”. He concluded: “Daniel would not have been with us today without a lung transplant, and we couldn’t have done the lung transplant without EVLP.” Royal Papworth Hospital performs a greater number of lung transplants than any other UK facility, having completed 41 such procedures in the preceding year. For updates on Cambridgeshire news, follow BBC Sounds, Facebook, Instagram, and X. Copyright 2024 BBC. All rights reserved. The BBC disclaims responsibility for the content found on external websites. Information regarding our external linking policy is available.