Increasing the Organ Supply Through Innovation
Expanding the Heart Donor Pool
The increasing acceptance of organs that would have previously been discarded has been made possible through an improved ability to minimize stress to organs as they go through the transplantation process.
An example of these extended criteria organs includes those donated after cardiac death (DCD). The biotech company TransMedics has developed an ex-vivo organ perfusion system that supports the donated hearts, maintaining them in a natural way that imitates the human body as it is transported to recipients. This Organ Care System (OCS™), currently under FDA review, is a novel technology that keeps donor hearts beating and lungs breathing prior to transplantation. Our department of surgery is one of the few centers to lead with this technology for both heart and lung transplantation.
Dr. Kenneth Liao, chief of the Division of Cardiovascular Transplantation and Circulatory Support, participated in the breakthrough Expand Heart Trial, which demonstrated that using the Transmedic OCS for donor heart resuscitation could increase successful transplantation using marginal donor hearts, hearts that would otherwise have been discarded.
Expanding the Lung Donor Pool
The rate of donor lung use is the lowest among solid organs; although the reasons for donor lung discard are complex, one factor that impacts this practice is the degree of organ deterioration that occurs during cold ischemic storage.
To improve the potential use of these organs, our division is paving the way in several breakthrough trials related to ex vivo lung perfusion (EVLP). Dr. Gabriel Loor and his colleagues completed the EXPAND trials investigating the use of the portable Transmedic OCS™.
In this study 93 pairs of lungs were perfused, ventilated, and assessed while being maintained in this normothermic portable EVLP device, resulting in an 87% transplantation rate with excellent clinical outcomes. These findings were published in The Lancet Respiratory Medicine.
In addition, the Thoracic Organ Perfusion (TOP) registry is the largest post-market approval registry for portable EVLP, for which Dr. Loor has been able to provide lead enrollment through his large pool of patients. Dr. Loor has been asked to direct another related clinical trial investigating the ideal blood-based perfusate for the portable EVLP.
With this solid foundation in EVLP research, Dr. Loor and his team now aim to further extend the exciting potential of this important organ-conserving technology by identifying critical cellular components to circulate through donor lungs that will make them less susceptible to inflammation, fibrosis, injury, and graft failure.
Using the knowledge, he learned from the Expand Heart Trial, Dr. Liao and his team of scientists are investigating how the OCS can be used to resuscitate and identify DCD hearts for safe transplantation and best outcomes. He is the recipient of a $3.6 million dollar grant from Brockman Foundation for his study “Increasing Heart Transplantation by Using Hearts from Donors after Circulatory Death.”