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What are the barriers to wider use of organ perfusion?

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INSIGHTS

UNOS Chief Medical Officer David Klassen, M.D., discusses perfusion-driven advances and remaining challenges

Normothermic perfusion continues to show promise as an innovation that will help increase the number of donor organs available for transplant. With perfusion, circulation and normal body temperature and function are maintained for the organ, making it possible both to evaluate the organ and potentially to limit the impact of ischemic time. However, cost, technology and training considerations remain barriers to widespread implementation. UNOS Chief Medical Officer Dr. David Klassen discusses recent developments in the field.
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Explore issues in normothermic perfusion with a curated reading list

Q. Where is perfusion having the most impact right now in organ transplantation?

We’re seeing a steady increase in the number of organs being perfused. In 2022, more than 1,100 transplanted donor livers, hearts and lungs were perfused. Between 2018 and 2022, there was an almost five-fold increase in perfused livers transplanted, from fewer than 100 to nearly 500.

Perhaps the most important recent development is perfusion for DCD (donation after circulatory death) heart transplantation. Because the heart is particularly vulnerable to warm ischemic injury, increasing the number of successful DCD heart transplants was really dependent on perfusion technologies. A third of all donors are DCD donors, and potentially a significant number could be heart donors; one study estimated that widespread adoption of DCD heart transplant could lead to 300 more adult heart transplants annually.  UNOS data show that the number of DCD hearts perfused and transplanted has gone from 0 in 2018 to 199 in 2022.

photo Dr. David Klassen, UNOS Chief Medical Officer

“Perhaps the most important recent development is perfusion for DCD (donation after circulatory death) heart transplantation.”

David Klassen, M.D., Chief Medical Officer

Q. Are there other significant new developments?

In addition to ex-vivo machine perfusion, normothermic regional perfusion (NRP) for recovery of organs from DCD donors is now spreading fairly widely, and is also helping to increase the number of DCD hearts available for transplant. (See Normothermic Regional Perfusion: A reading list.) With NRP, cardiopulmonary bypass or ECMO is used to restore circulation and enable perfusion of DCD organs prior to recovery. Because these technologies are already in use in most ICUs, there is no new technology to acquire or learn to use, as there is with ex-vivo machines. Also with NRP, separate perfusion devices for each organ aren’t needed, as abdominal and thoracic organs can be perfused before recovery with this process.

Q. What barriers remain to greater use of perfusion?

At the present time cost remains the most significant limiting factor for either type of perfusion. It’s expensive, and questions have yet to be resolved about when it is most appropriate to use perfusion,  who pays for it, and how those costs are reimbursed.  Whether cost will limit the use of perfusion to larger and better-resourced transplant centers or OPOs remains to be seen.

Implementation of these technologies is also logistically complex.   It takes time and effort for new technologies and procedures like these to be widely incorporated.

Finally, more data are needed to firmly determine whether perfusion leads to better patient outcomes. Research so far indicates generally equal outcomes when compared with non-perfused organs.  Despite these questions perfusion is enabling increased use of expanded criteria and DCD organs, including those that previously might not have been considered viable for transplant.

A reading list

Understanding Normothermic Regional Perfusion (NRP)

Rather than perfusing donor organs by machine after recovery (“ex-vivo” perfusion), NRP uses extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass technology to restore circulation and perfuse DCD donor organs prior to recovery from the deceased donor. The advantages of NRP include the potential to reduce warm ischemia time for DCD donor organs and the ability to assess DCD hearts prior to recovery.

However, NRP is technically complex and requires rapid, coordinated execution by a skilled team. To ensure success with the procedure, the recovery team may need to bring all the necessary equipment and supplies, as well as its own perfusionists, which can add to the cost and other considerations of procurement.

In addition, questions have been raised even within the medical community about the ethics of a procedure that restores circulation in a deceased donor as well as about the transparency necessary for true informed consent from donor families.

This reading list provides an overview of NRP as well as discussions and recent perfusion news coverage.

Oct. 2022 | American Society of Anesthesiologists: “Statement on Controlled Organ Donation After Circulatory Death”

April 2021 | The American College of Physicians: “The American College of Physicians says organ procurement method raises significant ethical concerns”

Feb. 2020 | The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine: “Why DCD donors are dead” An ethical and philosophical analysis of NRP and DCD transplant.

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Another record year for heart transplants: Steep increases seen in DCD transplants in 2022

in focus

A 68% increase in DCD heart transplants was part of a record-setting 2022

68% increase in DCD heart transplants in 2022

The 11th straight year of increases in heart transplants coincides with advancements in organ perfusion technology and DCD recovery practices.

In 2022, 42,888 organ transplants were performed in the United States, an increase of 3.7 percent over 2021 and a new annual overall record.*

While new records were also set for liver, kidney and lung transplants, heart transplants in particular experienced a steep increase, from both donation after brain death (DBD) donors, as well as donation after circulatory death (DCD) donors.

Heart transplants increased overall by 21.5 percent (4,169 in 2022)

DBD heart transplants increased 4.6 percent (3,822 in 2022)

DCD heart transplants increased 68 percent (347 in 2022)

Advances in technology and donor recovery practices contributing to increases

Rapidly-evolving perfusion technology is allowing more DCD hearts to be transplanted. Perfusion allows organs to remain viable for longer periods outside the body; this is important for organs such as hearts and lungs, which have shorter windows of time when compared to kidneys. 2022 saw a 95 percent increase in transplants of machine-perfused hearts.

Coinciding with these advances in technology, increasing recovery of DCD donors has been a key area of focus for the nation’s 56 organ procurement organizations (OPOs) for a number of years. A recent UNOS-led collaborative project helped OPOs share effective practices related to recovering DCD donors to increase transplant. Over the course of the national project, 75 percent of OPOs participated in one or both of the two cohorts, contributing to the overall increases in DCD donors recovered and DCD organs transplanted. A subsequent collaborative project is currently focused on increasing transplantation of DCD lungs, and more than 40 percent of the nation’s lung transplant programs are participating.  

A report from the National Academies of Sciences, Engineering and Medicine (NASEM) recommends taking collaborative improvement approaches as well as embracing innovative technologies to maximize organ use, in particular use of DCD organs.  

February is American Heart Month. Get resources, fact sheets and other information on the National Institutes of Health website.  


*According to the most recent data from the Organ Procurement and Transplantation Network (accessed Feb. 13, 2023)

In focus

February is American Heart Month

7 years of HOPE

7 years of HOPE

Implemented in 2015 , the HIV Organ Policy Equity (HOPE) Act has given more than 350 living with HIV an opportunity to receive a lifesaving transplant from an HIV-positive donor.

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Process Engineer

Job Title: Process Engineer

Summary:  The process engineer is responsible for the installation, qualification, operation, supervision of a biomedical device assembly facility clean room.  The role includes developing standard operating protocols, training materials, scheduling, and reporting activities for manufacturing within a regulatory controlled environment.  This includes operations of the facility, electrical, process equipment , HVAC, high performance air filtering, and cleaning.

The process engineer is responsible for handling multiple projects for the lifecycle of the controlled environment including commissioning  and qualifications activities to decommissioning.  He or she will be responsible for organizing, budgeting, scheduling, carrying out, instruction, and supervision of the project as directed by company leadership.

Company Overview: Hibernicor is an innovative medical device company that manufactures single use disposable containers which will be marketed for sale in the US and Europe.

Key Position Responsibilities:

The process engineer will be responsible for defining the critical quality attributes, and process parameters in the clean room including particulate levels, relative humidity, and temperature parameters in a GMP compliant manner. The engineer should define the clean room requirements in a user requirements document and solicit input from qualified vendors following established ISPE/ASTM methodologies and guidance.

The process engineer will perform and maintain a risk assessment for all the critical process parameters including quality assurance, quality control, commissioning, validation, manufacturing safety, automation, and project management.  This may include researching, developing and acting on plans  using in depth knowledge of ISO and 21 CFR Part 11 and other regulatory guidelines.

The process engineer will prepare commissioning and qualification protocols, standard operating procedures, and work instructions as needed for equipment and facility operations aligning with an overall master validation plan.  The engineer should be able to write the validation master plan, commissioning and validation documents for the clean room, HVAC systems, and equipment; specifically design qualification, installation qualification, operational qualification, and procedure qualification documents (DQ/IQ/OQ/PQ).  The engineer should be able to prepare checklist and complete inspections that includes both static and dynamic exhaustive testing of systems or major system components to support the qualification of equipment or system based upon manufactures acceptance test or user requirements specifications (FAT/SAT).

The process engineer must of have experience and understanding of clean room facility and requirements.  In addition the engineer must have knowledge of computer system validation requirement and preparation and execution of protocol related to computerized systems provided by vendors. The engineer will supervise with the help of contractors on daily basis with follow up and completion of qualifying activities and GMP documentation including: clean room fitment, filter, HVAC and software automation testing and audit trail verifications.

The process engineer will supervise progress of the commissioning and qualifying activities on a periodic basis and hold status meetings with the stakeholders.  The engineer will maintain alignment to the budgetary guidelines, quality and safety standards.  The engineer will need to maintain and update quality control documents in an existing electronic GMP compliant document management system.

The process engineer will need to manage multiple task to coordinate projects timelines and work collaboratively with vendors and stakeholders to mitigate risk, facilitate problem solving, and to reduce  or avoid delays.

Minimum employee qualifications:

Bachelor degree in engineering or science field
US citizen or permanent resident
A minimum of 3 years of professional experience leading, initiating and completing projects.
Experience with statistical data and an ability to effectively perform technical analysis
Experience making risk based decisions
Experience navigating and adhering to structured system requirements (i.e. Quality Management System)
Demonstrated effective communication of technical information, both verbally and in written reports
Ability and willingness to respond beyond normal business hours (including weekends).

Desired position skills in:

Working in a clean room environment and understanding facility infrastructure, as it relates to supporting a clean room.
Working knowledge of environmental standards (FDA 21 CFR Part 11, ISO 14644, ISO 14698, etc.)
Understanding  of bioburden, endotoxins, particulate, etc. and conducting statistical analysis thereof.

Reporting: The packaging engineer reports to the quality manager and company director.

Location: The location of the job is at the company offices either in the US. If travel may be necessary to accomplish the job responsibilities and is anticipated to be no more than 10% of the employment.

Type of Employment: The position is full time.

Salary Range & Benefits: The salary and benefits are commensurate with the applicant’s qualifications and experience.

How to Apply: Please submit a cover letter, resume and 3 references with contact information. We will respond to suitable candidates by email to setup an initial telephone interview.

Contact Information:

HIBERNICOR LLC
253 Ridge Drive
Jackson, MS 39216
Email:

UNOS CEO Brian Shepard to leave organization after a decade of service

United Network for Organ Sharing (UNOS) today announced that CEO Brian Shepard will depart the organization at the end of September, following the completion of his contract. Shepard’s 10-year tenure as UNOS CEO was marked by groundbreaking progress in the U.S. organ donation and transplantation system.

Maureen McBride, Ph.D., UNOS’ chief operating officer, will assume the role of interim CEO beginning Oct. 1 while UNOS conducts a national search for Shepard’s successor. McBride has been with the organization since 1995. She served as director of research until 2014, when she accepted her current role as COO.

Brian Shepard, CEO, United Network for Organ Sharing

A commitment to improving the system

During his tenure, Shepard presided over the adoption of innovative policies, lifesaving improvements and record increases in both organ donation and transplant, including 2021, when the national system conducted more than 41,000 transplants in a single year, a global record. These and other advancements have positioned UNOS to drive the next phase of system progress, from increasing equity in transplant to adopting cutting-edge technologies, to collaborative improvement, further strengthening the nation’s high performing system and saving more lives.

“As UNOS CEO, Brian was a constant and courageous advocate for increasing equity in our national donation and transplantation system,” said Jerry McCauley, M.D., vice-president of the UNOS Board of Directors and incoming president. “His leadership has resulted in marked improvements in access to transplant for patients of color and those who have been historically marginalized. I am proud to have worked alongside Brian as a member of the UNOS board and am excited to build upon the foundation he has laid to further advance our mission and save even more lives.”

“UNOS is the engine that powers the U.S. donation and transplant system, and we are so lucky to have had Brian Shepard in the driver’s seat for the past decade,” said Matthew Cooper, M.D., president of the UNOS Board of Directors. “During such a pivotal time in our community, Brian took UNOS to the next level, driving accomplishments and championing the work of so many. His is a legacy to be celebrated.”

Prioritizing patients, equity and innovation

Under Shepard’s leadership, UNOS undertook a series of efforts to increase equitable access to transplant, including adopting a new way to distribute donor organs that emphasizes patient need. These new polices have resulted in greater access for the sickest patients.

“These changes to organ distribution weren’t easy or always popular, and it was so important to have Brian centering these discussions,” said David Mulligan, M.D., immediate past president of the UNOS board. “Now that these policies are in place, we can see the positive impact they’re having on patients and families across the country.”

Additionally, Shepard was instrumental in the development of UNOS Labs, an innovation center dedicated to fostering new ideas and encouraging experimentation. Since its founding, UNOS Labs has developed transplant-focused predictive analytics to help doctors decide whether to accept an organ offer for their patient, a GPS tracker for organ shipments, an offer simulator to conduct behavioral science research to improve organ matching, and a high-quality medical image sharing platform.

“The UNOS team is the most incredibly talented and dedicated team I’ve ever had the honor of being a part of,” said Shepard. “I’ve always viewed my job as making their job easier; removing obstacles and watching them run. I’m so proud of what they’ve accomplished and of all of the ongoing efforts that will further improve donation and transplant in the U.S.”

A vision for the future of organ allocation

Over the last several years, Shepard has helped put into place a new allocation policy, called continuous distribution. This innovative approach dissolves rigid boundaries, and is structured so that no single attribute determines whether or not a patient receives a transplant. Importantly, continuous distribution is also designed to allow for more patient engagement in the decision-making process.

“As a three-decade heart transplant survivor who strongly advocates increased involvement for transplant patients in the policy development process, continuous distribution is a game changer,” said Jim Gleason, president of Transplant Recipients International Organization (TRIO). Gleason has engaged with UNOS for more than 25 years and is a two-term former UNOS Board member. “This effort is not only going to help guide patients to the information they need in their transplant journey, it will also give them an active contributor seat at the decision-making table.”

A lasting legacy

“From policymaking to technology, from system-wide improvements to one-on-one interactions, Brian’s leadership has left an indelible mark on UNOS and the wider donation and transplant community,” said Sue Dunn, former CEO of Donor Alliance and a former UNOS board president. “But for me, to see his ongoing commitment to honoring selfless donors, their courageous families, and recognizing the often-thankless work of our OPOs – that is a legacy be proud of.”

“We’ve come such a long way in the last decade,” said Shepard. “While I am honored that the Board asked me to continue to serve as CEO, I felt it was the right time to take the next step. I have worked with so many amazing and dedicated people over the years who made it possible to accomplish all that I originally set out to do as UNOS CEO. Now, as we embark on a new chapter with even more exciting opportunities, I know the UNOS team and the donation and transplant community are in good hands, and I’m excited about the future.”

United Network for Organ Sharing (UNOS) is the mission-driven non-profit serving as the nation’s transplant system under contract with the federal government. We lead the network of transplant hospitals, organ procurement organizations, and thousands of volunteers who are dedicated to honoring the gifts of life entrusted to us and to making lifesaving transplants possible for patients in need. Working together, we leverage data and advances in science and technology to continuously strengthen the system, increase the number of organs recovered and the number of transplants performed, and ensure patients across the nation have equitable access to transplant.

For media inquiries, contact newsroom@unos.org or (804) 782-4730.

The post appeared first on UNOS.

[Approval] Donors after circulatory death heart trial

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Future Cardiol. 2021 Jan;17(1):11-17. doi: 10.2217/fca-2020-0070. Epub 2020 Jul 6.

ABSTRACT

Orthotopic heart transplantation is the gold standard treatment for end-stage heart failure. However, the persistent shortage of available donor organs has resulted in an ever-increasing waitlist and longer waiting periods for transplantation. On the contrary, increasing the number of heart transplants by preserving extended criteria donors and donation after circulatory death hearts with the Organ Care System™ (OCS) Heart System has the potential to provide the gold standard, life-saving treatment to patients with end-stage heart failure. The objective of the Donation After Circulatory Death Heart Trial is to evaluate the effectiveness of the OCS Heart System to preserve and assess hearts donated after circulatory death for transplantation to increase the pool of donor hearts available for transplantation, which can potentially provide patients with end-stage heart failure with the life-saving treatment. Clinical Trial Registration: NCT03831048 (ClinicalTrials.gov).

PMID:32628044 | DOI:10.2217/fca-2020-0070

[Approval] A Low-Cost Perfusate Alternative for Ex Vivo Lung Perfusion

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Transplant Proc. 2020 Dec;52(10):2941-2946. doi: 10.1016/j.transproceed.2020.05.007. Epub 2020 Jul 2.

ABSTRACT

BACKGROUND: Normothermic ex vivo lung perfusion (EVLP) has been used successfully to evaluate and recondition marginal donor lungs; however, multiple barriers continue to prevent its widespread adoption. We sought to develop a common hospital ingredient-derived perfusate (CHIP) with equivalent functional and inflammatory characteristics to a standard Krebs-Henseleit buffer with 8% serum albumin-derived perfusate (KHB-Alb) to improve access and reduce costs of ex vivo organ perfusion.

METHODS: Sixteen porcine lungs were perfused using negative pressure ventilation (NPV) EVLP for 12 hours in a normothermic state and were allocated equally to 2 groups: KHB-Alb vs CHIP. Physiological parameters, cytokine profiles, and edema formation were compared between treatment groups.

RESULTS: Perfused lungs in both groups demonstrated equivalent oxygenation (partial pressure of arterial oxygen/fraction of inspired oxygen ratio >350 mm Hg) and physiological parameters. There was equivalent generation of tumor necrosis factor-α and IL-6, irrespective of perfusate solution used, when comparing CHIP vs KHB-Alb. Pig lungs developed equivalent edema formation between groups (CHIP: 15.8 ± 4.8%, KHB-Alb 19.5 ± 4.4%, P > .05).

CONCLUSION: A perfusate derived of common hospital ingredients provides equivalent results to a standard Krebs-Henseleit buffer with 8% serum albumin-based perfusate in NPV-EVLP.

PMID:32624230 | DOI:10.1016/j.transproceed.2020.05.007

[Approval] HSP90 Inhibitor Improves Lung Protection in Porcine Model of Donation After Circulatory Arrest

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Ann Thorac Surg. 2020 Dec;110(6):1861-1868. doi: 10.1016/j.athoracsur.2020.05.079. Epub 2020 Jul 9.

ABSTRACT

BACKGROUND: Ischemia-reperfusion associated with prolonged warm ischemia during donation after circulatory death (DCD) induces acute lung injury. The objective of this study was to combine ex vivo lung perfusion (EVLP) and a heat shock protein-90 inhibitor (HSP90i) to recondition DCD organs and prevent primary graft dysfunction.

METHODS: Pigs (55 to 65 kg) were anesthetized, ventilated, and hemodynamically monitored. Cardiac arrest was induced with potassium chloride, and animals were left nonventilated for 2 hours. Lungs were procured and perfused in an EVLP platform for 4 hours by using a cellular perfusate. In the study group, the perfusate contained HSP90i and its transport vehicle (n = 4). In the control group, the perfusate contained only the transport vehicle (n = 4). Gas exchange, airway pressures, and compliance were measured. Pulmonary edema was assessed by bronchoscopy and weight measurement. Lung biopsy samples were obtained for histologic analyses and protein expression measurements.

RESULTS: The use of HSP90i reduced lung weight gain to 8.4 ± 3.4% vs 26.6 ± 6.2% in the control group (P < .05). There was reduced edema formation. The ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen at the end of EVLP was 423 ± 65 in the study group vs 339 ± 25 mm Hg in the control group, but this difference was not statistically significant. Lactate metabolism, pulmonary vascular resistance, and pulmonary arterial pressure improved during EVLP with the use of the HSP90i.

CONCLUSIONS: The use of HSP90i with EVLP improves the lung reconditioning process. Further research is required to confirm whether these findings translate to benefit once transplanted and observed in vivo. Successful pharmacologic inhibitors may expand the donor pool in the context of DCD donors.

PMID:32652069 | DOI:10.1016/j.athoracsur.2020.05.079

[Approval] Machine perfusion of donor heart with normothermic blood versus hypothermic HTK in preserving coronary endothelium in a porcine model of DCD

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Ann Palliat Med. 2020 Jul;9(4):1476-1487. doi: 10.21037/apm-20-131. Epub 2020 Jul 13.

ABSTRACT

BACKGROUND: Both machine perfusion (MP) of donor hearts with autologous blood and crystalloid perfusates have advantages and disadvantages. Currently, which of the aforementioned preservation strategies can better preserve the coronary endothelium has not yet been determined. We aim to compare the impact of hypothermic continuous MP with histidine-tryptophan-ketoglutarate (HTK) solution versus normothermic continuous MP with autologous blood on coronary endothelium in a porcine ex vivo model of donation following circulatory death (DCD).

METHODS: DCD pigs underwent circulatory arrest via asphyxiation followed by 30-minute warm ischemia time. Donor hearts were preserved with either hypothermic MP with HTK solution (MP + HTK group; 4 ℃; n=6), or normothermic MP with blood (MP + blood group; 37 ℃; n=6) for 4 hours. After 2-hour ex vivo reperfusion, the assessment of endothelial-dependent (Edep) and -independent (Eind) relaxation of coronary artery, histopathological analysis, and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay were performed.

RESULTS: Preservation of DCD hearts with MP + Blood strategy significantly improved both Edep and Eind vasorelaxation of coronary artery compared with MP + HTK strategy (maximum relaxation to bradykinin: MP + HTK 80.9%±2.6% vs. MP + Blood 91.9%±1.9%, P<0.001; maximum relaxation to sodium nitroprusside: MP + HTK 97.1%±1.0% vs. MP + Blood 99.8%±0.2%, P<0.05). MP + Blood strategy significantly decreased nitrotyrosine but increased intercellular adhesion molecule-1 immunoreactivity in the coronary artery. The number of TUNEL-positive cells in MP + Blood group were significantly fewer compared with MP + HTK group.

CONCLUSIONS: Compared with MP + HTK strategy, MP + Blood strategy significantly alleviates coronary endothelial dysfunction during donor heart preservation. This protective effect is associated with the inhibition of apoptosis and nitro-oxidative stress in coronary artery.

PMID:32692200 | DOI:10.21037/apm-20-131

[Approval] Mitochondrial transplantation for myocardial protection in ex-situ-perfused hearts donated after circulatory death

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J Heart Lung Transplant. 2020 Jun 29:S1053-2498(20)31625-9. doi: 10.1016/j.healun.2020.06.023. Online ahead of print.

ABSTRACT

BACKGROUND: Donation after circulatory death (DCD) offers an additional source of cardiac allografts, potentially allowing expansion of the donor pool, but is limited owing to the effects of ischemia. In this study, we investigated the efficacy of mitochondrial transplantation to enhance myocardial function of DCD hearts.

METHODS: Circulatory death was induced in Yorkshire pigs (40-50 kg, n = 29) by a cessation of mechanical ventilation. After 20 minutes of warm ischemia, cardioplegia was administered. The hearts were then reperfused on an ex-situ blood perfusion system. After 15 minutes of reperfusion, hearts received either vehicle alone (vehicle ; n = 6) received a second injection of mitochondria (5 × 109 in 10 ml) after 2 hours of ex-situ heart perfusion and reperfused for an additional 2 hours. A Sham group (sham hearts; n = 6) did not undergo any warm ischemia.

RESULTS: At the end of 4 hours of reperfusion, MT and MTS groups showed a significantly increased left ventricle/ventricular peak developed pressure (p = 0.002), maximal left ventricle/ventricular pressure rise (p < 0.001), fractional shortening (p < 0.001), and myocardial oxygen consumption (p = 0.004) compared with VEH. Infarct size was significantly decreased in MT and MTS groups compared with VEH (p < 0.001). No differences were found in arterial lactate levels among or within groups throughout reperfusion.

CONCLUSIONS: Mitochondrial transplantation significantly preserves myocardial function and oxygen consumption in DCD hearts, thus providing a possible option for expanding the heart donor pool.

PMID:32703639 | DOI:10.1016/j.healun.2020.06.023

[Approval] Progress of Clinical Application for Ex Vivo Lung Perfusion (EVLP) in Lung Transplantation

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Methods Mol Biol. 2020;2204:217-224. doi: 10.1007/978-1-0716-0904-0_19.

ABSTRACT

In recent years, medical advances make lung transplantation become a standard treatment for terminal lung diseases (such as emphysema, pulmonary fibrosis, pulmonary cystic fibrosis, and pulmonary arterial hypertension) that cannot be cured by drugs or surgery (Lund et al., J Heart Lung Transplant 34:1244, 2015). However, the current number of donor lungs that meet the transplant criteria is no longer sufficient for transplanting, causing some patients to die while waiting for a suitable lung. Current methods for improving the situation of shortage of lung transplant donors include the use of donation after cardiac death (DCD) donors, smoker donors, and Ex Vivo Lung Perfusion (EVLP). Among them, EVLP is a technique for extending lung preservation time and repairing lung injury in the field of lung transplantation. By continuously assessing and improving the function of marginal donor lungs, EVLP increases the number of lungs that meet the transplant criteria and, to some extent, alleviates the current situation of shortage of donor lungs. This chapter reviews the clinical application and research progress of EVLP in the field of lung transplantation.

PMID:32710328 | DOI:10.1007/978-1-0716-0904-0_19