Organs in a box
Our series Life out of Death continues with Aaron Leaman talking to two medical specialists who see organs in a box as the future for transplants.
Watching a pair of human lungs expand and contract inside a box is no longer the stuff of science fiction.
Lung specialists at Melbourne’s The Alfred hospital have recently acquired a lung perfusion machine, colloquially known as a lung in a box.
It’s hoped such technology will open up new opportunities in organ donation in Australia and New Zealand.
Professor Greg Snell, head of The Alfred’s lung transplant service, predicts the technology will become common in lung transplants within five years.
The hospital received the lung perfusion machine in October and has yet to use it on a patient.
The machine cost about $500,000.
‘‘With this machine, you can see the lungs working outside the body and evaluate them and play with them and improve them and decide if they are working well before you put them in somebody else,’’ Snell said.
‘‘You can send blood into the lungs and see whether the lungs can pick up oxygen and get rid of carbon dioxide. If the lungs look squashed, bruised, or have got fluid in them, you can dry them out.’’
Snell said the box was able to extend the time lungs could be out of the body, from the current eight hours, to 18 hours.
In Victoria, lungs are accepted from donors up to the age of 75. In New Zealand, and the rest of Australia, the maximum age for lung donors is 70.
Snell said Victoria had taken the approach it was better for patients to have lungs that work, even if they were a bit old or not perfect.
More than 50 per cent of lungs transplanted at The Alfred come from smokers, compared to 15 per cent in the United States.
In 2009, 29 per cent of patients on The Alfred’s lung waiting list died before receiving a new organ. Today, that figure is less than five per cent.
The Alfred has carried out about 95 lung transplants this year, compared to 38 in 2009. Post operative survival has also improved during that period.
Despite the cost of using a lung perfusion machine, estimated to be about $20,000 each time, Snell said the machine could save health dollars. ‘‘If we can use the box to treat and improve the lungs, we could save on intensive care days. The intensive care days can be $2000 a day, not to mention the misery and risk to the patient that goes with it.’’
Dr Sam Radford, an intensivist (critical care specialist) at Melbourne’s Austin Hospital and DonateLife Victoria’s deputy state medical director, said colleagues were looking at using machine perfusion technology with livers.
Radford said livers are fragile to ischemia (inadequate blood supply to an organ).
‘‘The time period of when you die and have the organ removed is very tight for livers. A large number of livers in DCD (donation after circulatory death) go to the grave. What our team is trying to do is take a DCD liver, run it on a machine, perfuse it, give it oxygen, give it nutrients, and assess it over time, and turn what would otherwise go to the grave into a transplantable organ.’’
Austin Hospital has already successfully trialled such a set-up in a tub, with blood perfused into a liver and the organ producing bile.
Radford estimates a liver in a box could make its way into everyday practice at the Austin within two to five years. The initiative could ultimately benefit those on the liver waiting list in New Zealand.
In 2016, eight livers from Australian deceased donors were transplanted in New Zealand.
Liver in the box technology could extend the time frame in which an organ can be in transit.
‘‘This [liver in a box] could change a $50,000 jet ride, into a first class ticket the next morning on Air New Zealand,’’ Radford said.
‘‘This [liver in a box] could change a $50,000 jet ride, into a first class ticket the next morning on Air New Zealand’’ Dr Sam Radford