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Physicians Update

 
Winter 2013

From Beating Hearts to Breathing Lungs:

New Technologies Increase Use of Donor Organs















The OrganCare System simulates the conditions of the human body and allows donor lungs to continue functioning normally in a near-physiologic "breathing" state outside of the body.

More than 1,600 people in the United States are currently awaiting a lung transplant, yet more than 70 percent of available donor lungs will ultimately be discarded because of poor organ quality or distance between the donor and recipient. An experimental organ-preservation device may help to increase the utilization of available organs by keeping donor lungs functioning in a near-physiologic "breathing" state while being transported for transplantation.

"Lungs are very sensitive and can easily be damaged during the donation process," explains cardiothoracic surgeon Abbas Ardehali, MD, surgical director of the UCLA Lung and Heart and Lung Transplant Program. "This new 'breathing lung' technology enables us to potentially transport lungs over longer distances, which will expand our donor pool, as well as improve the function of donor organs before they are placed in the recipient."

In November 2012, the lung-transplant team at Ronald Reagan UCLA Medical Center successfully performed the nation's first "breathing lung" transplant, using the experimental organ-preservation device known as the Organ Care System (OCS). OCS simulates the conditions of the human body and allows the lung to continue functioning normally in a warm, breathing state, continually perfused with oxygenated, nutrient-rich blood. It also enables surgeons to assess lung function, clean the airways, infuse medications and even repair the lung before transplantation.

The current standard of care, cold ischemic storage, involves transporting the donor lung in a nonfunctioning, non-breathing state inside an icebox.

"Human organs were never meant to be put on ice in a cooler," Dr. Ardehali explains. "Too many patients die because we have a shortage of suitable donor organs. This technology enables us to maintain the organ in better shape before transplant."

The key principles that mark OCS as a powerful and potentially revolutionary technology in lung transplantation build upon those developed and evaluated earlier in the "beating heart" clinical trial conducted at UCLA and four other leading heart-transplant centers in the U.S. As principal investigator, Dr. Ardehali helped to improve the safety and effectiveness of OCS in heart transplantation by refining functional and metabolic testing to enable more comprehensive organ assessment.

"Before, we used crude parameters to assess donor hearts," Dr. Ardehali says. "Over the past few years, we have developed better mechanisms to evaluate how well the heart is being preserved, and this knowledge is being used around the world."

OCS also has the potential to reduce the risk of organ rejection and increase the number of hearts accepted for transplant. Eventually, Dr. Ardehali says, it may even be possible to "warehouse" functioning organs for longer periods in order to facilitate better donor-recipient matches and allow time to modify some of the donor organs that would otherwise be rejected.

But not all patients will receive or accept a human heart or lung. As a high-volume organ transplant center, UCLA has also contributed to the advancement of artificial devices, such as left ventricular-assist devices, which are used to partially or completely replace the function of a failing heart for patients who are awaiting transplants or to provide emergency support to patients with failing hearts caused by severe episodes of rejection. To date, more than 200 artificial devices have been implanted at UCLA.





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