A pioneering technique which breathes new life into previously unusable donor lungs could save the lives of many patients on the lung transplant waiting list.

Newcastle University is co-ordinating the pioneering UK wide study which cleans and aerates the donor lungs after they are removed from the donor. 

Currently only one in five of the potential donor lungs available in the UK are used in lung transplants, the rest are turned down as they are in too poor a condition to safely transplant.  Close to a third of those waiting for a lung transplant at any one time will never be matched with a donor organ. Sadly, this means that many patients who would benefit from a lung transplant will die before suitable donor lungs are identified.

The new technique is being piloted by Newcastle University and Newcastle Hospitals NHS Foundation Trust experts in a small scale study could mean many more donor lungs become available for transplant.

Already shown to work in eight patients in the pilot, the DEVELOP-UK study will now bring together all the lung transplant centres across the country  to test the new technique to find out to what extent it could increase the numbers of donor lungs available for transplant on a UK wide basis. The work is being funded by the Department of Health via the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme with additional funding provided by the Cystic Fibrosis Trust.

The technique called ex-vivo lung perfusion or EVLP transforms previously unusable donor lungs into lungs which can be safely used for transplant. In effect the organs are cleaned and their function improved by attaching them, after they are removed from the donor, to a modified heart-lung bypass machine which pumps a specialised nutrient liquid through, while at the same time providing the lungs with oxygen via a breathing machine.

The shortage of organ donors in the UK is made even more dramatic for those waiting for lung transplant as donor lungs are particularly delicate and can be easily damaged by events that happen before their removal from the donor. That means patients are often called in for a transplant, only to have their hopes dashed because the donor lungs are in too poor a condition to safely go ahead.

Professor Andrew Fisher who is leading the research team running the DEVELOP-UK study said: "Unfortunately lungs are an incredibly delicate organ and they are easily damaged by events that happen before their removal from the donor. If we can make more of the donor lungs currently turned down available for transplant that will be a great benefit to many patients whose lives are severely limited by their severe breathing problems.

"We know already from experience in a small numbers of patients that this technique can work, we now need to prove it on a large scale, so that EVLP can be rolled-out across the country as a new technology in lung transplantation.

"If we can show that survival in the first 12 months after transplant with EVLP improved lungs is comparable to that achieved with standard donor lungs then we will know this is a successful and effective technique for the NHS. However, we will also carefully check in the study that there are no more early complications, such as a longer stay on intensive care or more frequent infections or episodes of transplant rejection in the EVLP improved lungs compared to standard donor lungs."

Ed Owen, chief executive of the Cystic Fibrosis Trust, said:  "The CF Trust is striving for all people with Cystic Fibrosis who require a transplant to receive one. Sadly many people currently die before lungs become available. The EVLP research is revolutionary for people with CF as it makes more lungs available and therefore offers real hope and life for many people. The CF Trust with our partners the Robert Luff Foundation are therefore delighted to be supporting this essential research." 

James Neuberger, Medical Director, Organ Donation and Transplantation, for NHS Blood and Transplant, said: "There remains a severe shortage of organs donated for transplantation and we desperately need more people to donate and to make as best use of those organs that are donated so that more lives can be saved. We therefore warmly welcome this initiative that will look at novel ways in which more lungs can be made available for transplantation and save more lives."

Chris Watson, President of the British Transplantation Society, said the study could offer hope to transplant patients. "The BTS wishes to congratulate the DEVELOP-UK research team for setting up this study.  It is the first study to include all the lung transplant units in the UK and has the potential to change dramatically the availability of lungs for transplantation.  Currently around a quarter of potential recipients die in the first year while waiting for suitable lungs and this study has the potential to transform that situation for the benefit of all the patients waiting for a lung transplant," he said.

The DEVELOP-UK study is multi-centre involving all five officially designated NHS adult lung transplant centres, namely Harefield Hospital in London, Papworth Hospital in Cambridge, Queen Elizabeth Hospital in Birmingham, Wythenshawe Hospital in Manchester and Freeman Hospital in Newcastle. The study is open to all adult patients aged 18 years and over with advanced lung disease already on an active lung transplant waiting list in one of the five centres and any new adult patients as they are added to the waiting list

"I was too out of breath to do anything" 

Philippa Bradbury, from Mirfield, near Huddersfield, was diagnosed with Cystic Fibrosis (CF) at fifteen months old and as time went on her lung condition worsened and she had to give up her university course. She was put on the lung transplant waiting list at Newcastle's Freeman Hospital and within five months she'd had four calls for transplant, but each time the donor lungs were unusable.

But Philippa, 21, was able to benefit from lungs that were reconditioned using the new technique performed by experts at Newcastle University. It meant that Philippa was able to get her lung transplant sooner and massively improve her quality of life.

Philippa, who is running in the Yorkshire 10k in May, said: "Before the transplant I was in and out of hospital, my quality of life had really gone down. Unlike my friends of similar ages I wasn't able to enjoy the spontaneity of going out and enjoying myself. I became too tired and too out of breath to do anything.  After the Transplant I was only in hospital for 11 days, because the reconditioned lungs were perfect. It was amazingly quick."

published on: 30 May 2012