Top 10 Innovations for 2013
#7 Ex Vivo Lung Perfusion
The respiratory system, consisting of the lungs and air passages, provides the body
with a continuous supply of oxygen as well as a means of removing carbon dioxide.
The life-sustaining oxygen that we inhale 17,000 times a day passes from the lungs
to the bloodstream, which distributes the oxygen to cells throughout the body.
Respiratory disorders serious enough to cause long-term breathing problems are
common in the United States and will increase in prevalence as the Baby Boom
population ages. Almost 400,000 Americans die of lung diseases every year, and
over 35 million are now living with chronic lung disease.
Fortunately, technological advances are producing opportunities to replace lungs
permanently damaged by end-stage diseases such as chronic obstructive pulmonary
disease, cystic fibrosis, pulmonary hypertension, or alpha-1 antitrypsin deficiency. As
a result, people with these disorders are living longer and better lives today than just
a decade ago.
Since the early 1990s, more than 25,000 lung transplants have been performed
at medical centers around the world. In the United States, more than 1,800 lung
transplants out of a pool of over 100,000 potential candidates are expected to be
completed in 2012. These patients had no other medical options and were expected
to die from lung disease within one to two years.
While lung transplantation is a lifesaver, donor lung shortage is a major limiting factor
to the number of transplants that can be performed annually. Lungs are harvested
from only 15 percent of donors due to the lung's vulnerability to complications that
arise before and after donor brain deaths such as pneumonia, thoracic trauma,
ventilator associated lung injury, or pulmonary edema.
That is all about to change. Experts believe that as many as 40 percent of previously
rejected donor lungs may now be suitable for transplantation thanks to a new
approach called ex vivo—outside the body—lung perfusion. This novel "lung washing"
procedure can reverse lung injury in many donor organs deemed unsuitable and allow
With scores of successful transplantation cases of ex vivo lungs that have been repaired and regenerated,
this is not science fiction. In this new pioneering procedure, the damaged lungs are removed from a donor,
placed in a bubble-like transparent chamber, and connected to a cardiopulmonary pump and a ventilator.
Over a four- to six-hour period, the lungs are then repaired and assessed. Special proprietary fluids are
forced through the blood vessels and nutrients are used to renourish the lungs as they inflate and deflate as
oxygen is pumped through. When necessary, targeted medications are introduced to clear infections. Once
determined as being viable, they are ready for immediate transplantation.
Ex vivo lung perfusion, which is approved in Europe and Canada, and is now undergoing a major multicenter
clinical trial in the United States, has the potential to significantly increase the number of available
lungs as the reconditioning process is adopted, refined, and improved at multiple transplant centers. This
increased availability of quality-tested donor lungs is going to make a huge difference to the 100,000
American patients with severe breathing problems who now wait on the lung transplant standby list.