Cardiothoracic surgeon Dr. John Dunning and team performed the transplantation of  donor lung kept “breathing” in human-like conditions

For all the advances in organ transplantation, most organs are still transferred from donor to recipient in a cooler packed with ice. The clock begins ticking as soon as the donor organ is recovered – and in the case of a heart or lung, for instance, a transplant is usually no longer viable after four to six hours.

Now, the USF Health Heart and Lung Transplant Program at Tampa General Hospital (TGH) has become the first in the state to use or formally study the sophisticated organ transplant system designed to keep donor lungs and hearts healthier longer and increase the number of transplants.  TGH is also assessing the Organ Care System (OCS™ ), manufactured by medical device company TransMedics Inc., for use in extending the life of donor livers.

Video footage courtesy of TransMedics, Inc.

The first lung transplant in Florida using this system was performed Oct. 22, 2019 by a team led by John Dunning, MD, professor of cardiothoracic surgery at the USF Health Morsani College of Medicine and surgical director for Health and Lung Transplantation at TGH. (The FDA has already approved the OCS technology for lung transplant, but its use for hearts and livers is still investigational.)

TGH is among the top 10 busiest transplant centers in the nation, having now performed more than 10,000 transplant operations.

The new OCS technology – often referred to as “lung in a box” or “heart in a box” — allows the donor organ to keep functioning almost as if it were still inside the human body while it is transported to the hospital in a portable sterile machine equipped with probes and tubing. During a process called normal temperature perfusion, the organ is oxygenated and nourished with continuously circulating blood. The flow of blood prompts the heart to continue beating, the lungs breathe with a puff of ventilator air, and the liver produces bile. A touch-screen tablet lets surgeons assess the fitness of organs right up to the time they arrive in the operating room for transplant.

“We can maintain the organs for longer periods, which means we can retrieve them from a wider geographic area,” Dr. Dunning said. “And the condition of the organs at the time of transplant is better,” compared to the conventional method.

Dr. John Dunning, USF Health professor of cardiothoracic surgery at Tampa General Hospital, led the first Florida lung transplant using the OCS technology.

The conventional way involves covering the organ with preservation solution in a plastic bag and putting it on ice in a cooler, but this cold storage can limit tissue survival time, especially over long distances.  The OCS uses a different approach, transporting the organs at a warmer, near-normal body temperature.

The process has been shown to reduce the risk of rejection in lung transplants, and organs in some cases become healthier after being placed in the high-tech OCS machines.  For example, a potential donor who is on a ventilator in a hospital might develop fluid in their lungs as a side effect.  But this can clear up when the lung is placed in the OCS.  This improvement means more organs not considered healthy enough for donation in the past are likely to become medically suitable for transplantation to treat end-stage heart, lung or liver disease.

“We can actually monitor their function on the machine and see their function improving prior to transplantation,” Dr. Dunning said.

Each year, the number of patients on the waiting list continues to be much larger than both the slower growing number of donors and transplants. The U.S. Health Services & Resources Administration estimates 20 people die each day waiting for a transplant. Health professionals hope that new preservation technology like the OCS can safely reduce the dire shortage of lungs, hearts and other organs for transplantation, in part by making organs previously excluded due to age, oxygenation complications and other donor selection criteria acceptable.

Traditionally donor lungs come from deceased patients declared brain dead. But the OCS also allows lung transplants from patients after cardiac (circulatory) death, which could potentially expand the donor pool by 20 to 30 percent.

Dr. Dunning is Florida principal investigator for a multicenter post-approval study known as the OCS Lung TOP registry, which will track both the survival and outcomes of patients who receive transplants of OCS-preserved organs and the quality of the organs themselves. He is also among a handful of lead investigators from academic medical centers nationwide participating in a pivotal clinical trial to evaluate the safety and effectiveness of the OCS for heart transplantation after circulatory death.