Current Events
New transplant technology keeps organs ‘alive’ outside body
By Jacque Wilson, CNN
updated 12:01 PM EDT, Thu April 25, 2013
(CNN) — In every medical drama the scene is the same: The surgeon carefully places the delicate organ in a cooler filled with ice and snaps the lid shut. The transplant team then sprints toward the door, hoping to reach its patient in time.
That speed isn’t just for dramatic effect. Transplant teams rush because they have less than eight hours to transport the organ to the operating room, prepare it for surgery and implant it into the recipient’s body.
“Beyond that time, there is significant injury to the (organ), which makes it unusable,” said Dr. Abbas Ardehali, director of UCLA’s heart and lung transplant program.
Placing healthy organs in the same container we use to keep soda cold at a picnic seems archaic. But until recently, it was the only option hospitals had.
That changed with heart-in-a-box.
In 2006, surgeons in Europe transplanted the first heart using the TransMedics Organ Care System, a portable device that kept the heart “alive” — beating, with blood and oxygen flowing through it — during transport. In 2011, doctors began successfully transplanting lungs using a similar device.
While the system has been approved for use in Europe — more than 200 live organ transplants have been completed to date — clinical trials are still wrapping up in the United States. Interim results from those studies are being presented at the annual International Society for Heart and Lung Transplantation meeting in Montreal this week.
Approximately 60% of lung recipients die in the first five years following surgery due to complications, according to the National Institutes of Health; scientists hope to change that statistic with this new technology.
Woman needs 4 organs to survive
There are three potential benefits to keeping donor organs “alive,” said Ardehali, who is UCLA’s principal investigator for one of the studies.
The first is obvious: Organs that are kept warm and functioning instead of being placed on ice have less damage, so the recipient’s body doesn’t have to work as hard to accept it, Ardehali said. That may improve patient outcomes.
Doctors measure a lung transplant patient’s “primary graft dysfunction” in the days following surgery, said Neal Beswick, vice president of global marketing for TransMedics. That’s basically an indicator of how well the new lungs are working. Past studies have shown that patients with high grades of graft dysfunction in the first 48 hours have a higher risk of organ rejection and early mortality later on, Beswick said.
Preliminary results from the U.S. breathing lung transplant studies suggest this new method significantly reduces primary graft dysfunction. Patients who underwent live organ transplants during the study also spent less time on a mechanical ventilator, less time in the intensive care unit and had fewer lung-related complications.
The portable transplant system also enables doctors to keep organs outside the body longer, giving hospitals the opportunity to share them across a larger geographic region. More than 114,000 people in the United States are awaiting organ donations, according to Organdonor.gov; 18 of them die each day without a donation.
Iraq vet undergoes successful double-arm transplant
“We’d like to increase lung transplantation by a factor of three,” Beswick said. “And we think that we could double the number of heart transplants without any increase in the number of organ donors.”
Eventually, scientists may even be able to improve donor organs that would otherwise be discarded, Ardehali said.
Currently, 75 to 80% of donor lungs are rejected because they are infected or have too much damage, he said. If doctors are able to keep the lungs, or other organs, alive outside the body for several days, they may be able to clear up any infection with antibiotics or improve the organs’ resilience.
It’s a bit of “science fiction” right now, Beswick said, but doctors in the future could even use the TransMedics device to fight chronic diseases. For example, if doctors could remove the lungs of a stage IV cancer patient and attack the organs with radiation outside the body, they could potentially place the same cancer-free lungs back in the patient a few days later, effectively eliminating the need for donor lungs at all.
“A lot of things become real become real if the organ can be sustained for a long period of time,” Beswick said.
Hospitals pay approximately 45,000 euros — or $58,000 — for each TransMedic Organ Care System. While the hardware can be reused, the organ chamber must be disposed of after each transplant, Beswick said. “It’s a relatively high cost per patient.”
TransMedic hopes to finish the U.S. heart trial in the next 90 days; the lung trial should be done by the end of the year. The company then hopes to submit their device to the U.S. Food and Drug Administration for approval.
Up until 2006 all organ transplants were very risky. As soon and the donated organ was removed it was put into an icebox and rushed to the recipient. The surgeons had under eight hours to get it to the surgery and insert it. If any more time is spent the organ is damaged and can no longer be used. Then is 2006 the Heart-in-a-box was invented, this device kept the heart beating and pumped blood and air through it, therefor the organ was still “alive”. In 2011 doctors began to use a similar device to keep lungs “alive”. Before this system 60% of lung receivers died, due to their body rejecting the “dead” organ. There are three advantages to this system: the first is that the organ is kept warm and working, instead of being put on ice. This will hopefully make it easier for the body to receive the organ. Second, in the days after the surgery the doctors measure “primary graft dysfunction”, this shows how well the lung is working. The patients with a higher grade of “primary graft dysfunction” are more likely to have a rejection and to die. Studies show that “live” organ transplant patients are less likely to have “primary graft dysfunction”. Finally, the device lets the doctors keep the organ out of the body for longer periods of time, this gives them the ability to share them with other hospitals around the country, preventing deaths while they are on the waiting list. While these devices are currently at work in Europe the U.S. Food and Drug Administration still must approve them for use in the U.S. They hope that the heart-in-a-box will be approved in the next 90 days and the Lung version by the end of this year.
In my opinion I think this is a great invention. It will save so many people’s lives. It will also help people have a better life. I also think that the U.S. Food and Drug Administration should work on getting these inventions approved sooner as apposed to later so we can save more lives.