The human lung is an amazing organ. When you die, your brain, heart, liver, and kidneys will all shut down within minutes and begin to decompose. But unlike those organs, your lungs don’t depend on circulating blood to get oxygen. They can get it from the air. Your lung cells will stay alive for hours after the rest of your body has died. 

Infographic: The lung shortage
Infographic: click to enlarge

Despite the lung’s unusual longevity, there are never enough donor lungs to meet the demand. Lung diseases—emphysema, cystic fibrosis, pulmonary fibrosis, and others—are the third-leading cause of death in the United States, killing 200,000 people every year. New lungs could help thousands of them live longer, fuller lives.

Tom Egan, a professor of surgery at UNC, sees a solution to the shortage. And now he’s using lungs from donors in Wake County, North Carolina, to revolutionize standard transplant practices and make sure there are finally enough lungs to go around.

A new donor pool

A typical set of donor lungs comes from a person who has suffered some catastrophic injury that lands him in a hospital. Doctors put him on a ventilator and scramble to save him. But eventually, days or even weeks later, the patient is declared brain-dead.

Infographic: More lungs for transplant
Infographic: click to enlarge

If he’s a registered organ donor, any healthy organs are then taken from his body, carefully packed, and helicoptered off to their new lives in wholly different bodies.

In an ideal situation, this includes the lungs. But some 80 percent of lungs that come from conventional organ donors have been ruined by the time the organs are harvested. Hospitals have to discard them.

That’s because hospitals—and the injuries that put people there in the first place—are hard on lungs.Ventilators can trigger pneumonia or infection. And tissue damage caused when blood and oxygen are suddenly restored, as when doctors restart a patient’s heart, is a common problem; doctors call it ischemia reperfusion injury.

Brain death introduces another complication, Egan says. Researchers are beginning to understand that when the brain dies, the innate immune system kicks into action and causes inflammation in the donor’s organs. That’s very bad for the patients who will eventually receive the organs, increasing their risk of graft dysfunction and death soon after the transplant.

But, Egan wondered, what if surgeons could have access to a different pool of organ donors? Ones who die outside of hospitals, away from lung-damaging equipment and hospital infections? Donors who die suddenly at home, on the road, or in work accidents? Egan calls these non-heart beating donors, and there are three quarters of a million of them in the United States every year.

“If we could get our hands on just the youngest 5 percent,” he says, “that’s more than thirty-five thousand donors. And since many patients would need single lungs, we could be doing upwards of fifty thousand transplants a year, easily.”

Better lungs, longer lives

Wake County has a population of over 900,000 and hundreds of sudden, unintentional deaths every year. Egan is working with county emergency medical services (EMS) to collect lungs from organ donors there who die suddenly.

The plan is to assess the lungs with CT scans and a method called ex vivo lung perfusion (picture donor lungs hooked up to a ventilator with deoxygenated fluid circulating through them) to determine whether they’re suitable for transplant. Lungs that pass the test will then be offered to potential recipients at UNC and Duke. Egan and his team will monitor these patients and compare their outcomes to those of patients who received lungs from conventional donors.

Previous studies have already shown that these lungs are safe to transplant. Egan hopes that this study will help him prove once and for all that this donor pool will not only provide more lungs, but lungs that are better than those being transplanted now.

Egan says that using organs from non-heart beating donors would mean that donor lungs would have to be routinely treated with ex vivo lung perfusion, which could reduce the danger of graft dysfunction and death caused by complications after the surgery.

Higher-quality donor lungs could make it possible for a greater number of older patients to get transplants, too. As it is, most older patients don’t even have the option. Graft dysfunction and surgery complications are riskier for them than for younger patients, and most doctors won’t put them on the waiting list.

Egan’s study in Wake County will be the first step to making organs from non-heart beating donors accessible to patients who need them. But on a nationwide scale, it’s going to be tough for transplant surgeons to get immediate access to these new donors.

EMS personnel, medical examiners, and emergency room personnel will have to go through extensive training. The policy changes alone are daunting.

It’s a challenge, Egan says. “But it’s a challenge we can deal with.”

Margarite Nathe

Thomas Egan is a professor of surgery in the School of Medicine at the University of North Carolina at Chapel Hill. His work is funded by the National Institutes of Health.