On the new season of House, in an episode named “Transplant”, the doctors place the lungs in this plexiglass box, so they can look at it, treat it, make jokes, say their lines, misdiagnose it a few times, harass the patient’s family, etc., before transplanting it into the patient. Here’s the team gathered around the boxed lungs:
And I also told you how that is laughable: an organ for transplant will be cooled in iced bags full of fluids. Outside of the donor’s body, the organ will die, so I showed you the biochemistry behind keeping it alive, as well as practical aspects (rushing it through traffic to deliver it to the patient, or even flying in commercial airlines!).
But that is when I came across this image, of real lungs in a box:
At first I thought it was very hard to believe and thought it had to be a joke. There is even a video of a set of lungs “breathing” inside a box (be advised before you click on it: not for the squeamish):
After a little more research, I found an LA Times article from earlier this year describing “XVIVO”: a device with the purpose of keeping lungs alive for longer than hypothermia and preservative solutions can.
When consulted on his opinion of XVIVO, Dr. Airton Schneider, thoracic surgeon and chief of surgery at the Lutheran Hospital in Porto Alegre, Brazil, stated “the lungs are placed in perfusion and ventilation for a few hours, which decreases injury. The results are exciting. It means we can transplant almost in an elective way. There is less rejection and the chance of reperfusion injury is decreased”.
Coincidently or not, XVIVO is part of the research from Brazilian surgeon Marcelo Cypel, now working in Toronto. He published his research results at the New England Journal of Medicine. In the paper, titled “Normothermic Ex Vivo Lung Perfusion in Clinical Lung Transplantation”, the XVIVO device (actually called “normothermic ex vivo lung perfusion”, or EVLP) is used in 20 lung transplants. This new technique can be applied for lungs that could have been discarded due to tissue damage (which can be repaired while in the perfusion system), and can store it for at least 12 hours at room temperature. The group observed similar results when compared to transplants with conventionally selected lungs. This way, lungs can be kept alive for longer until crew is gathered; can be repaired, and more donors can be used.
There is no mention of cost in this technique. In Brazil, despite shortage in resources, almost all transplants are covered by the universal healthcare system, who pays the hospital approximately 70.000 reais (equivalent to 35.000 U.S. dollars) for a lung or liver transplant (if you think about it, hospitalization due to pneumonia in the US costs “merely” 20.000). This amount covers the surgery, staff, and immunosuppressant drugs. Factoring the XVIVO would undoubtedly increase this cost, but in the other hand would keep lungs alive for longer, and be able to use more donors. Apparently, the system is already in use in the developed world (with the exception of the US, where XVIVO is still waiting for FDA approval).
For Dr. Schneider, XVIVO is “the future, but right now. Imagine removing an organ in one major city, packaging it and shipping to a different city. Then perfuse, transplant, go.”
It seems Dr. House was not so absurd after all. Shame on me.