“Lung in a Box”
Abbas Ardehali, MD, FACS
Abbas Ardehali, MD, FACS, Director of UCLA Heart, Lung, and Heart-Lung Transplant
Programs at the David Geffen School of Medicine at UCLA, discusses a new technology that is
allowing organs to stay alive outside the human body for longer.
How many lung transplants do you do in a week?
Dr. Ardehali: UCLA is one of the busiest lung transplant programs in the country. We perform
somewhere in the vicinity of 80 to 90 lung transplants a year and it probably is in the top four or
five programs in the country in terms of the volume.
How long have you been doing lung transplants?
Dr. Ardehali: I have been involved in the UCLA lung transplant programs for nearly 14 years.
I read a quote from you that lungs should never be put on ice. Why is that?
Dr. Ardehali: That indeed is my belief. The human organ was never meant to be on ice so I
don’t think that lungs are exceptions to that rule. The human organs, be it the heart, the lung,
the kidney or liver, were never meant to be taken out of the human body and placed on ice for
transportation, even for a brief period of time.
Was that how it has been done in the past?
Dr. Ardehali: For the last 30 or 40 years that we’ve been doing lung transplants, we’ve always
sent a team out to where the donor is to procure the organ, stop the organ, specifically the lung,
and put the lung on ice. We bring the organ on ice in a cooler to UCLA where the transplant is
performed. During that time we are fighting against the clock because we need to minimize the
period that the organ is kept out of the human body and on ice.
What’s the time that you try to get it in?
Dr. Ardehali: We invariably like to keep it less than six hours. Once it goes beyond eight hours,
most transplant centers consider the organ non-usable, and the reason for that is a continual
element of injury to the organ as it’s kept on ice. This is the way we have been doing it for the
past 30 to 40 years. It makes intuitive sense when you think about it that if you can somehow
continue to breathe the lung and continue to have blood circulating through it, then that organ
would be a better organ at the time of transplant.
Now there is a way to do that, correct?
Dr. Ardehali: Now, there is a technology for the first time to keep a human organ alive outside
of the human body for hours, and use that same organ, transplant it into another human being,
and have that take over the body’s circulation and vital functions.
Tell me, what is the organ care system?
Dr. Ardehali: It is a platform to transport human organs while keeping a near physiologic state,
meaning nearly alive. Then after a few hours we transplant those same organs and allow them
the opportunity to resume the vital function of another human being.
Now you have eight hours traditionally. Does this buy you more time?
Dr. Ardehali: We believe it does. We believe that this has the potential to expand the duration
to potentially up to 12 maybe 24 hours, but we do not know that at this point. We are in the
stages of investigating this technology. This is a FDA trial which compares the old way of
transporting organs mainly on ice with a new way, which is in a warm breathing near physiologic
state. The study is a multi-center international study and we plan to enroll over 250 patients.
Once the study is complete, we will see if this technology is superior to the current method of
organ preservation.
How will you know that?
Dr. Ardehali: One of the parameters that we follow is how well the new lungs work after being
implanted. We speculate that with the lungs being kept in a breathing warm perfused state, the
organs that are transplanted are actually better organs.
What happens to the lungs when it is kept on ice? Do they not perform as well?
Dr. Ardehali: There is a finite injury to the organs on ice and that is why we have to fight
against the clock during those six to eight hours to make sure the transplant is done during that
period of time. We speculated that this technology decreases the severity of injury and
preserves the organ in a better shape at the time of the transplantation. So, we believe that we
may transplant better organs into patients.
If the organ is better, what does that mean for the patient? What were the drawbacks
before?
Dr. Ardehali: If the organs are better, we believe that the patients will do better. They will be
able to have fewer complications, stay in the hospital for a shorter period of time, and resume
their normal lifestyles sooner.
Can you tell me quickly how the box works?
Dr. Ardehali: So, the box is a self-contained platform that has a pump, a tank of oxygen, and a
lot of other machines and devices that circulate blood through the new lungs. There’s a tank that
infuses oxygen into the lungs and we also have a way of treating potential infections in the
donor lung; we can add antibiotics. We can also go to the airway of the new lungs and clear out
secretions, mucus, or other sort of secretions that are there. So we have an opportunity to
actually improve the quality of the organs that will ultimately be transplanted.
Is there any downside to this?
Dr. Ardehali: It’s interesting you mention that because when you talk to most people they say it
makes intuitive sense and why didn’t you guys come up with this 20 years ago? The reality is a
lot of people have put a lot of thought into this over the past several decades but the technology
was not there to have a self-contained platform to maintain the organ in a near physiologic
state. Now we are at a point in technology where this box is able to maintain that human organ
in a near normal state. As far as that organ is concerned, it still feels like it’s in a human body
because it’s still breathing, there’s still blood going through it, and as far as it knows it’s alive.
That I think is a fascinating aspect of this technology, which is to maintain a human organ in a
near live state for several hours outside of a human body and then transplant it into a recipient.
In terms of downsides, we will be investigating the safety of this device as part of this ongoing
study.
It has been done with hearts already, right?
Dr. Ardehali: It has been done in hearts and we are still completing the study. UCLA was
amongst the leaders in the heart study and we expect that within the next couple months we will
be completing the heart study. From a scientific standpoint I think the potential benefits of this
technology are several fold. We touched on part of one of the areas that you mentioned, which
is we believe this technology delivers a better organ for transplantation so ultimately the patients
will do better. I think the real promise of this technology is that it can potentially expand the
donor pool. There are about 75 to 80% of the lungs that we are not currently using because of a
variety of factors such as pneumonia or damage to the lungs because of the state of brain
death. We also have a lot of patients that are dying on the waiting list because there are not
enough organs. A real promise of this technology is if it can allow us to improve the quality of
the lungs that we are not currently using, to make them usable organs, it could potentially
change the game. You actually will be expanding the donor pool, offering this life saving therapy
to more patients, and potentially save many lives in the process. It is one thing to improve the
quality of the organs that we’re currently using, but I think the greatest promise is expanding the
donor pool and converting the organs that we are not currently using to usable organs.
The patient we’re talking to is the only patient?
Dr. Ardehali: No, we’ve done I think eleven or twelve patients.
Do you know the name of the patient?
Dr. Ardehali: Mr. Padilla.
He’s your patient?
Dr. Ardehali: Yes.
How is he doing?
Dr. Ardehali: He’s doing very well. He actually had a big operation and within a couple of
weeks he was home and able to be back with his family for the holidays. He’s progressing very
nicely from a lung standpoint.
What was he like when you first saw him?
Dr. Ardehali: He was quite limited. He had a condition called pulmonary fibrosis, which is a life
threatening condition and as you may know, there are no formal therapies available for patients
with end stage pulmonary fibrosis. Lung transplantation is the only option. He has had a
significant change in his quality of life and we are optimistic that he will have a very healthy and
prolonged life ahead of him.
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