The Future of Keeping Lungs Alive Outside the Body
“My lungs were garbage, and they didn’t know what it was.”
A current generation EVLP set up in Toronto. Screengrab: Youtube
Hélène Campbell was backpacking across Europe in 2011, like so many other high school graduates seeking to test their limits in a far-flung locale, when she noticed that she couldn't keep up with her friends. Hiking up a mild incline felt like scaling Everest, and she struggled to breathe. At first, she thought that she was just out of shape. She couldn't have been more wrong.
When she got back to her hometown of Ottawa, the 20 year-old—who was working as a hospital clerk at the time—received the worst news of her life: she had a rare and incurable disease called Idiopathic Pulmonary Fibrosis. Her lungs were becoming increasingly scarred to the point of unusability, and she didn't have much time to live. One year, to be exact. The only thing that could save her was a double-lung transplant.
"My lung function, when they discovered it, was about 26 percent," Campbell told me in an interview. "That was in July. When they admitted me to the hospital, they couldn't believe what they saw on the scans. They said that it looked like I had been a chain smoker for 60 years. My lungs were garbage, and they didn't know what it was."
A full set of lungs isn't like a kidney or a liver. Donors for the latter tend to be alive at the time of the transplant, but a complete set of pipes will typically come from someone who's brain dead, or who has died recently. This means that there's a potentially sizeable pool of donor lungs available, but most of them aren't considered for transplant if they've been damaged or filled with liquid during the dying process.
Ex vivo lung perfusion, or EVLP, is a recently invented medical procedure that essentially cheats death. An EVLP set up uses mechanical ventilators and a steady stream of a warm blood-like fluid to keep a set of lungs alive outside of a body. Doctors can then assess the lungs in detail and repair them, if needed. The Toronto General Hospital has a current generation EVLP set-up—a mechanical monstrosity of pumps, filters, ventilators, and connective tubes—and it's what saved Campbell's life.
"The volume of the donor lungs was far bigger than my cavity size," Campbell said. "They were able to reduce the lungs—they took the left-bottom lobe of the donor lungs went to make my left lung, and they took the bottom-right lobe on the right side of the donor lungs and made that my right lung. I have these mini-lungs, and they were able to do the operation because it was sitting on the ex vivo machine."
The operation was an unqualified success, save for an infection following the operation. Campbell's recovery and subsequent donor advocacy made her a bit of a celebrity. In 2013, she appeared on the Ellen Degeneres Show.
Despite Campbell's EVLP success story, the technology has some persistent issues: the equipment occupies an entire room, for one, and it isn't mobile, meaning that lungs have to be ferried to and from the set up on ice instead of going right to where they're needed. It's also a complex procedure and takes years to master.
Geoff Frost, a former engineering student at the University of Toronto currently studying to become a physician, co-founded a startup that's building a device to solve these issues. XOR Laboratories Toronto Inc. came into existence in 2013 while Frost was studying under Thomas Waddell, a thoracic surgeon at the University Health Network in Toronto.
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Frost and Waddell saw an opportunity to improve how EVLP is currently done and went about developing a dishwasher-sized device that can run the ventilation and fluid-pumping circuit—keeping a set of lungs alive—with the push of a few buttons.
"What we wanted to do was to make this thing much smaller and more mobile, so it's not taking up an entire operating room," Frost told me in an interview. "By not taking up an entire operating room, you save cost at the hospital. We also wanted to make it easier to do, so you don't have to waste two years of a surgeon's working life training to do this one procedure."
So far, Frost told me, his company has succeeded in creating a rough working prototype, although it's not ready to go into a sterile hospital environment just yet. That will come next year, if all goes well.
The device, which looks kind of like a George Foreman grill with a set of lungs on top instead of a steak, is kind of like a miniature "jungle gym" for lungs, Frost told me. Much like a full EVLP set up, the device ventilates the lungs and fills them with fluid.
His machine's advantage over the current room-filing iterations of EVLP devices, he told me, is hacking all the components that used to fill an entire room together into one compact package.
"This involves pumps, and it involves batteries," Frost said. "So, we have to pick the right ones that are light, we have to pick new components that are smaller, and we have to redesign the way everything sits in space so that we can squish it together in a really tiny volume."
XOR Laboratories' work is part of a rising tide of innovation in the realm of ex vivo techniques in organ transplantation. In the US, United Therapeutics, a biotech company founded by Martine Rothblatt—who also started Sirius satellite radio—recently partnered with the Mayo Clinic to build a facility specializing in cutting edge ex vivo lung restoration work. The goal, as with Frost's project, is to expand the pool of donor lungs."I wouldn't be alive without this technology," Campbell said of EVLP, during our interview. "It's crazy."