Transplantable Donor Lungs: A Case Study

The shortage of transplantable donor organs has profound consequences, especially for patients with end-stage lung disease, for which transplantation remains the only definitive treatment. Although advances in ex vivo lung perfusion have enabled the evaluation and reconditioning of marginally unacceptable donor lungs, clinical use of the technique is limited to ~6 h. Extending the duration of extracorporeal organ support from hours to days would enable longer recovery and recipient-specific manipulations of the donor lung, with the goal of expanding the donor organ pool and improving long-term outcomes. By using a clinically relevant swine model, here we report the development of a cross-circulation platform wherein recipient support enabled 36 h of normothermic perfusion that maintained healthy lungs and allowed for the recovery of injured lungs. Extended support enabled multiscale therapeutic interventions in all extracorporeal lungs. Lungs exceeded transplantation criteria, and recipients tolerated cross-circulation with no significant changes in physiologic parameters throughout 36 h of support. Our findings …show more content…
(1) Criteria expansion: the use of donors older than 55 years, or lungs donated following cardiac death9, 10, 11. (2) Extracorporeal devices: ex vivo lung perfusion (EVLP) to recondition marginally unacceptable donor lungs12. (3) Bioengineered lungs: tissue-engineering strategies utilizing stem cells and fully decellularized or bioartificial scaffolds13, 14, 15, 16, 17 to develop functional lungs de novo. (4) Xenogeneic lungs: genomic and immunologic alterations to enable the xenotransplantation of swine or non-human primate lung18,19, thereby providing a constant supply of donor organs. However, despite these efforts, the annual number of lung transplantations remains steady, and waitlist mortality continues to