2. Challenge of organ shortage is enormous, but we’re heading towards a future where we have time and ability to improve and augment organs before more and better transplants

Abstract

Over the past four decades, Lung transplant has evolved to a successful modality for treating end stage lung disease in selected patients. However, lung transplant is not problem-free. Primary graft dysfunction is the most severe form of post transplant lung ischemia and reperfusion injury and is correlated with early and late mortality after lung transplantation. Many studies have been performed to optimize the donor lung preservation in order to minimize ischemic injury to the donor lung. However, no major breakthrough has been made in donor lung preservation. Cold flush and storage has been accepted as a standard preservation of donor lungs in clinical lung transplantation. With the concept of living organ transplant, that is, heart beating, lung breathing, kidney making urine and liver producing bile, Transmedics developed a portable ex-vivo warm perfusion system that allows the donor lungs functioning and “breathing” in a near-physiologic state outside the body during transport, thus minimizing the donor lung ischemic time. Gregor Warnecke and his colleagues reported first-in-man experience of the portable OCS lung device for concomitant preservation, assessment and transport of donor lungs. It demonstrated that lungs can be safely preserved with the OCS lung, resulting in complete organ use and successful transplantation in their high-risk recipients. As one of the major lung transplant centers participating in the INSPIRE trial, the lung transplant team at Ronald Reagan UCLA medical center successfully performed the nation’s first “breathing lung” transplant in November, 2012. The INSPIRE trial has been conducted in leading lung transplant centers in Europe, the United States, Australia, and Canada. The interim results from the INSPIRE trial are suggesting significant improvement in post lung transplant clinical outcomes using the TransMedics OCS lung portable perfusion and ventilation system. In addition, other important clinical parameters such as in-hospital mortality, 6-month survival, rate of lung-related complications, time on mechanical ventilation and ICU stay may be better in the OCS group as compared to cold storage. With OCS, surgeons may accept suboptimal organs or those obtained from non-heart-beating donors through assessment of donor lung function at donor site, thus expending the donor pool without compromising patient outcome. The OCS lung enables surgeons to continuously monitor and assess the lung function and quality until transplantation. By doing so, it makes the recipient transplant team coordinate with the procure team easier, the timing of recipient incision more flexible. It allows two separate single lung transplantation that share lungs from one donor proceeding one after the other. OCS lung also allows surgeons to procure lungs over longer distance, leading to development of an international organ sharing system. We believe that this OCS lung technology has a potential of bringing human lung transplantation to a new cornerstone.