Home » Health » Erasmus MC fixes rejected lungs and can therefore do considerably more transplants

Erasmus MC fixes rejected lungs and can therefore do considerably more transplants

Not all people who donate organs after death have completely healthy lungs. Nevertheless, lungs that are in principle rejected do not have to be lost. With the so-called perfusion technique, lungs ‘with a scratch’ can also be successfully recycled.

This is done with a perfusion machine. In such a device, removed lungs are ventilated for four to six hours and flushed with a special fluid. Any damage to the lungs, for example due to the donor’s stay in the ICU, can be repaired. In some donors, the death process releases hormones that open blood vessels in the lungs. As a result, the lungs fill up with fluid and that makes the lung useless. This can be restored with perfusion.

Inflammation and embolisms

Medicines such as antibiotics, anti-inflammatory drugs or clot dissolvers to treat embolisms can also be administered. “We treated organs with pneumonia in this way. And lungs with a severe embolism, which is a blood clot in a blood vessel in the lung. Normally these lungs were definitely not approved for transplantation,” said lung specialist Rogier Hoek and cardio-thoracic surgeon. Edris Mahtab against the WE.

The technique has been developed in Sweden and Canada and is now also in use in transplantation centers in the Netherlands. There is a great shortage of donor lungs in our country. About 180 people are permanently on the waiting list for a transplant. The waiting time can be up to two years and it does happen that people die while they are on the waiting list. A computer program assesses who has a turn first. Lung transplants are only performed by the academic hospitals in Rotterdam, Utrecht and Groningen, a total of 109 times last year.

Donormanagement

In 2019 and 2020, 49 lung transplants have been performed at Erasmus MC so far. Fifteen of these had their lungs pre-perfused. In combination with a few other innovations, the number of transplants could be doubled. For example, doctors have been practicing what they call ‘active donor management’ for the past two years: “Donor management starts as soon as it is established that the patient will die. In that case, extra attention is paid to ventilation and fluid balance, so that the lungs do not needlessly damaged, ”says Hoek.

The recipient of the lungs are also prepared in an innovative way. For example, patients whose lung function threatens to drop below the minimum are connected to a machine that adds oxygen to the blood outside the body and thus takes over the function of the lungs. Surgeon Mahtab explains: “In this way we can wake people up and get them in sufficient condition to endure surgery. In the past they had to be taken off the waiting list.”

Hard?

The perfusion technique is also successfully used in Dutch hospitals for the improvement of livers and kidneys and a trial with hearts will soon start at Erasmus MC. “Then hopefully people who are waiting for a heart transplant will also benefit from it”, says Rogier Hoek.

In the Netherlands, sixty percent of patients are still alive ten years after a lung transplant. That is well above the international average of 40 percent. Most patients also experience a better quality of life than before the lung transplant.

Donorwet

The innovations do not mean that the waiting list will disappear, says lung specialist Hoek: “We have to work with donor lungs that are less good than before, because donors are aging on average. Moreover, recipients are sicker”.

The doctors hope that the new donor law will lead to more donors. Under the new law, valid since July 1, everyone is automatically a donor, unless he or she registers not to.

– .

Leave a Comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.