People are still dying while waiting for receiving lung transplantation. In Scandinavia alone, 46 persons died over the last three years. With more available lungs, those persons might have been alive today. This is only half the truths as it is expected that with more available lungs, more persons with terminal lung diseases would be placed on the waiting list and receive new lungs and an improved life. This EU-project aimed at improving the selection process of donated lungs. This is important as today only about 20 - 25% of donated lungs are being transplanted. The remaining 75 - 80% are discarded, most of the time due to an unsure quality. Ex Vivo Lung Perfusion (EVLP) is a technique developed to evaluate the functionality of lungs after removal from the donor, but before transplantation. The lung is circulated with a warm solution and ventilated with a conventional ventilator, which allows the clinicians to investigate how well the vasculature and the alveolar performs its basics task of gas exchange. All is done in a controlled environment not to pose a risk of damaging the lung during the procedure. The safety of EVLP has been proven in clinical studies performed in the US, Austria, Canada and otherwise. In fact, some clinical data suggests that the procedure even offers protective effects to the lung as the reperfusion (re-entering) of circulated blood (solution), is done in a more careful way, than what can be done in a patient. If this beneficial effect is significant, it means than not only do more patients receive lungs, the lung transplantation patients might also have a longer and healthier life after the transplantation, than what they would have had with conventional lung transplantation.
EVLP has proven its clinical value to increase the number of lungs available for transplantation. Within the first years, the increase, at a center level, is about 30% more lung transplantations generated through EVLP. The limit with EVLP is that the analysis is partly based on subjective criteria. This is acceptable as long as the technique is only used by the most experienced centers, but with dissemination of the technique, more objective parameters would facilitate the use of EVLP and increase security in term of organ function. This project aimed at identifying objective markers of lung function during EVLP. Although a clinical trial is required to determine the success of the project, initial data support the view that significant biomarkers have been identified within the project.
The project has also thoroughly investigated the user needs and it has identified different technology platforms that could be used to improve the objectivity of the EVLP-process. All in all, the project has generated a strong position for future development of EVLP and therefore to offer more lungs to dying persons.
