Creamy-pink and glistening, they lie on a stainless steel exam table — this pair of lungs inflating and falling in a rhythmic, ghostly pattern.
At the University of Michigan, researchers are pushing the limits of medicine, eking out new ways to boost the numbers of organs that are available to thousands of patients who die every year waiting for them.
That means, for a time at least, keeping human lungs — particularly delicate organs — “alive” outside the body.
“I’ve been in medicine for years, and I still think it’s wild … almost science fiction,” said Dr. Paul Lange, medical director of Gift of Life Michigan.
It’s also an unprecedented collaboration — the University of Michigan, Gift of Life Michigan and Henry Ford and Spectrum health systems — now poised to become part of a national clinical trial using a $250,000 piece of equipment purchased by Gift of Life, the organization responsible for recovering and delivering organs at eight sites around the state.
It’s the kind of round-the-clock logistics work in which minutes matter.
“Outside the body, without blood and oxygen, those cells start deteriorating quickly,” Lange said.
With the XVIVO Perfusion System, or XPS, doctors hope to keep lungs sustained outside the body long enough to give them more time to determine whether the organs are viable for transplant. If all goes well, the lungs eventually could be kept viable for days — giving them time to heal before transplant, doctors say.
Earlier this week, the U.S. Food and Drug Administration approved the machine for use in human lungs for “humanitarian” cases — in other words, for patients for whom all other options have run out. Doctors in the clinical trial, including those in the Michigan collaborative, want the machine to be available routinely.
“So one day, could we have a warehouse of hearts being kept alive of different sizes and call up and say ‘I need a heart for a 2-year-old’ and the next day it comes in the mail?” said U-M’s Dr. Robert Bartlett, who helped invent the technology in the 1960s on which the XPS is now based.
It seems fanciful, he acknowledges. But Bartlett remembers the days when there was little more to do for a heart attack patient after surgery than to keep the room quiet and hope for the best. He was part of the intensive care units that are now standard in most hospitals — offering new ways to keep people alive after their hearts stopped, lungs weakened and kidneys gave out.
And he helped develop, while he was in Boston, a modified heart-lung machine called extracorporeal membrane oxygenation (ECMO).
More than a traditional ventilator that forces oxygen to help a patient breathe, the ECMO also circulates a patient’s blood. It has saved thousands of lives since it was developed in the 1960s and 1970s, and earlier this year, ECMO machines at U-M kept alive Michigan residents struck down by H1N1.
And Bartlett remembers, too, the days when the idea of transplanting organs from one patient to another seemed crazy.
The XPS machine — the new technology being tested here — is already being used in Canada and Europe, either as a temporary bridge to lung transplants or to evaluate the health of lungs awaiting transplant.
On this day at U-M, pinkish liquid coursed through tubes sutured to the lungs that had been cut from a laboratory pig just hours earlier and attached to the XPS, a machine that looks vaguely like a Zamboni.
It beeped. Its monitor blinked. The lungs continued to rise and fall.
This, Bartlett said, “is the extreme of life support.”
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SOURCE: USA Today
Robin Erb, Detroit Free Press