Long waiting lists are a fact of life for patients waiting for a donor organ. Each year, about 41 000 patients in Europe receive a transplant, while at the same time another 48 000 are added to a waiting list. To make more donor organs available, doctors are increasingly forced to use organs that have deteriorated. This is because of insufficient or no oxygen and nutrient supply during their retrieval from the donor’s body, storage and transplantation. New techniques trialled by the EU-funded COPE project may now help to address this issue and increase the number of optimal kidneys and livers available for transplantation. “We have to accept more organs to avoid waiting lists getting even longer,” stated project coordinator Rutger Ploeg of the University of Oxford’s Nuffield Department of Surgical Sciences in a news item posted on the ‘Open Access Government’ website. “These new techniques allow us to assess donated livers and kidneys more effectively and to achieve better results when we transplant them,” Ploeg added. The novel methods involve machine perfusion that produces a continuous flow of a liquid called perfusate through the donated organ before it is transplanted. Focusing on kidneys and livers, the project team trialled two techniques that yielded better results than the customary organ transportation in ice boxes.
Livers at body temperature
In the clinical trials on liver transplantation, the project team tested the effectiveness of the normothermic machine perfusion (NMP) method. In other words, instead of storing the liver in cold liquid, perfusion occurred at body temperature. With this method, a great improvement was noted in organ function right after the transplant. Surgeons had longer than the usual 10 hours from the moment of organ retrieval to prepare for the operation. “Liver NMP was found to be a safe and more effective method of preservation than static cold storage, reducing graft injury and organ discard rates,” as stated on the project website.
Oxygen for kidneys
The project’s approach for kidneys involved oxygenated cold machine perfusion. The trial’s results showed that when the perfusate is enriched with oxygen, it improves kidney function, lowers the risk that the transplant will fail and also halves the risk that the recipient’s body will reject the donor organ. The COPE (Consortium on Organ Preservation in Europe) project that ended in 2018 helped to introduce organ preservation techniques that will increase the number of viable livers and kidneys for transplantation. However, there’s still work to be done to ensure a greater number of successful transplants. As Ploeg noted in the news item, “[i]n the European context, collaboration between transplant centres is crucial. For us in the medical community, the EU is the perfect mechanism to allow clinical research to happen across borders and benefit patients.” For more information, please see: COPE project website
COPE, donor organ, kidney, liver, transplant