Providing heart and lung care to a geographic area the size of Western Europe, which more than seven million Canadians across Alberta, Saskatchewan, British Columbia, Manitoba, Nunavut, the Yukon and the Northwest Territories call home, the Mazankowski Alberta Heart Institute’s heart and lung transplant program has had to get creative to save lives.

"The device is making a significant impact in the availability of donor organs for recipients who are waiting on transplantation."

Making treatment mobile

As part of an international, multi-centre trial, experts at the institute were the first in Canada to bring the portable ex-vivo lung perfusion machine to clinical use.

The ex-vivo device allows more lung transplants to be performed and improves the chances of positive outcomes for a transplant patient. Experts at the institute have also been able to use the device outside of the clinical trial.

Before the portable ex-vivo, which translates as ‘out of body’, was introduced, donor lungs would be kept on ice for up to eight hours during transportation, during which time the lungs would often deteriorate to such a level that they were no longer suitable for transplantation.

“The device is making a significant impact in the availability of donor organs for recipients who are waiting on transplantation,” explains Dr. Darren Freed, Cardiac Surgeon at the Mazankowski.

“Last year, we tied the most ever transplantations since the inception of the program in 1986, so we are very pleased with how the ex-vivo has impacted the availability of donor organs.”

The technology

The ex-vivo maintains donated lungs at a normal body temperature inside a sterile plastic dome, which is attached to a ventilator. The lungs are infused with a bloodless solution of oxygen, nutrients and proteins, a process that can reverse any lung damage before transplantation.

The use of the machine, as intended by the manufacturer, employs banked blood in the perfusate.

“The portable device allows us to retrieve marginal lungs and then bring them back to home base as they’re being perfused, evaluated and reconditioned,” says Dr. Freed.

In the transit phase, a wireless monitor lets clinicians continuously assess the function of the lungs to make sure they are still viable.

“Using the ex-vivo, we were able to see that the drug had worked and then make the transplant, which has been successful.”

Saving lives

Dr. David Ross, Head, Cardiac Surgery, Edmonton Zone, tells the story of a young mother with cystic fibrosis who was in desperate need of a lung transplant. A good donor came up, but died suddenly from a massive blood clot to the lungs.

“In the past, that would’ve meant that those lungs would be deemed not suitable for transplantation, but we were able to put them onto the ex-vivo machine and give them a commonly used clot busting drug,” says Dr. Ross.

“Using the ex-vivo, we were able to see that the drug had worked and then make the transplant, which has been successful.”

Pursuing further breakthroughs

Dr. Freed and his colleagues have been investigating how ex-vivo technology can be applied to making more donor hearts suitable for transplantation. His lab is currently building a new device which allows doctors to evaluate heart function in the same way that they can with lung function.

“We wanted to create a system that would allow the heart to pump blood to both the left and right ventricles so that we could evaluate both sides of the heart,” Dr. Freed explains.

“It boiled down to the clinical need for a device that would give us the options and metrics that we require to make informed decisions about transplants.”

Development of the device is progressing well and it has been demonstrated successfully on over 100 pigs’ hearts.

Dr. Freed and his team have been able to demonstrate that they can reliably and reproducibly measure heart function, with a high discrimination between hearts that are suitable for transplantation and those that are not.

Dr. Freed is in no doubt that this device could be a game changer for patients who require a heart transplant. “Relatively quickly we could have a 25 to 50 percent increase in the heart transplant activity if we were able to use this technology,” he says.