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Lungs’ Unique Viability: Transplant Procedure Seeks To Save Lives

By Rachel Nash Posted November 20, 2013 at 4:00 pm

CHAPEL HILL –  Lungs have the ability to live longer than other organs after a person dies. If the lungs are recovered from an organ donor in time, it may lead to transplant operations that could save thousands of lives.

With a $4.2 million National Institutes of Health grant, the UNC School of Medicine is breaking ground with a clinical trial that tests an innovative method of recovering healthy lungs from donors who suffer sudden death outside a hospital.

Dr. Thomas Egan, professor of cardiothoracic surgery at the UNC of Medicine, is leading the trial. Through research, he found the lungs’ unique ability to stay alive.

“The reason the lung lives for hours after people die is because the lung has a supply of oxygen in all of the tiny little air sacs in the airwaves,” Egan says. “The cell in those airwaves and air sacs live off oxygen in the lungs, and they don’t rely on blood flow in order to get oxygen.”

Other organs require oxygen to be present through blood circulation.

Only 1,800 lungs a year are transplanted from conventional, brain dead organ donors who have died in a hospital. And many of that number, only 25 percent are found to be suitable for transplant.

“There maybe upwards of 40,000 patients that might be candidates for lung transplants to help them breathe better and live longer in frankly a much more improved quality of life if there were enough lungs to transplant.”

Egan says there is a great need for healthy lungs.

“Lung disease is now the third-leading cause of deaths in the United States,” he says. “While it is far behind cancer and cardiovascular disease, there are close to 200,000 deaths every year from in-stage lung disease.”

The trial has two crucial parts. The first step is retrieving the lungs, departing from the normal donation process.

Currently, the organs of registered donors who die outside of hospitals are not used. This is where Egan says the difference can be made.

There is a one to two hour window for the lungs to be recovered after the donor has died.

If emergency workers determine that the patient cannot be resuscitated, the local organ recovery agency will step in to contact the next-of-kin for permission to participate in the clinical trial.

Once permission is granted, emergency workers will then pump a small amount of air into the lungs to preserve them during the transport to a hospital.

Part two of the trial begins once the lungs arrive at the hospital.

Inside a dome-shaped machine, Egan’s lab perfuses and ventilates the lungs with a special solution to determine suitability for transplantation. The liquid is met to flow like blood would inside the lungs.

When the lungs are found to be healthy, the organs will be transplanted to patients who have consented under FDA- and IRB-approved standards and practices.

The trial pools together the cooperation of organizations such as the emergency rooms of UNC and Duke Hospitals; Wake County EMS; and Carolina Donor Services, the regional organ procurement organization.

If the trial proves successful, Egan believes it could lead to revolutionizing the organ donation process in the United States.

“Other organs might be salvaged down the road if we can change the whole paradigm of what happens to individuals after death if they have indicated a desire to be an organ donor.”

Egan was recruited by the UNC School of Medicine to start the lung transplant program in 1989.

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