New process triples preservation time between organ removal and transplantation

Shaf Keshavjee, MD, MSc, FACS, FRCSC
Shaf Keshavjee, MD, MSc, FACS, FRCSC

Shaf Keshavjee, MD, MSc, FACS, FRCSC, and his colleagues at the University of Toronto, ON, have developed new techniques in organ preparation and preservation that have more than tripled the time between organ removal and implantation, dramatically expanding the pool of available organs and the number of transplantation procedures that can be performed.

“We have developed a strategy of personalized medicine for the organ to be transplanted,” said Dr. Keshavjee, surgeon-in-chief, Sprott Department of Surgery, University Health Network, University of Toronto. “We can diagnose organs consented for transplant, treat those organs, and prepare them for transplant. This new system has allowed us to increase our number of lung transplants by 50 percent. We have gone from doing 100 lung transplants a year at Toronto General Hospital to doing 150.”

Dr. Keshavjee will describe this new approach during Monday’s John H. Gibbon, Jr., Lecture, The Future of Transplantation: Personalized Medicine for the Organ. The strategy was created for lung transplantation but has been expanded into liver, kidney, and heart transplants.

In most centers, organ transplantation is a race against the clock. Once removed from the donor, organs are flushed with a cold solution to slow metabolism and delay death. Most U.S. centers require no more than a six-hour delay between lung removal from the donor to implantation in the recipient. In this small window, there’s no time to repair the organ, to help it recover from prior trauma or injury, or to improve its function before implantation.

Using the new approach developed by Dr. Keshavjee and his team, there’s more time to keep the lung outside the body, diagnose it, and treat it in a personalized fashion to repair specific injuries and make it better for transplantation.

“We now have the opportunity to prepare the lung for the transplantation procedure and to prepare it to be seen by the host immune system so that it looks more like [a host organ] and is less likely to be rejected,” Dr. Keshavjee said. “It has already changed how we manage organs and will change how transplantation will be practiced in the future. It looks like science fiction, yet has become standard practice in our hospital.”

About 350 patients have been treated at multiple centers using the new procedure. The process allows for delays of 20 hours and longer between removal and implantation. In practical terms, the lung transplant center at Toronto General can, and does, source lungs from Alaska, Vancouver, BC, and the rest of North America.

And whereas traditional transplantation procedures make it possible for approximately 20 percent of consented organs to be implanted, the new process makes it possible for 40 to 50 percent of consented organs to be transplanted. The goal is to implant 60 percent of consented organs, Dr. Keshavjee said.

Dr. Keshavjee’s team also is laying the groundwork for a new system of organ collection and preparation using freestanding organ repair centers. The first organ repair center is housed at Toronto General Hospital with a second facility in Silver Springs, MD. A third organ repair center is being built in Jacksonville, FL.

“We have already handled 70 lungs at the Silver Springs facility,” Dr. Keshavjee said. “We are collecting and preparing lungs for transplantation at the University of Maryland [Baltimore], Cleveland Clinic [OH], Mayo Clinic [Rochester, MN], and the University of Pittsburgh [PA]. And we have started companies to build devices that can automate the organ repair process. We are engineering super organs for transplantation.”

The John H. Gibbon, Jr., Lecture was established in 1971 to honor Dr. Gibbon, a pioneer in open-heart surgery, and is sponsored by the Advisory Council for Cardiothoracic Surgery.