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. There are about 180 people 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 them 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 to improve the liver and kidneys. And soon a trial with hearts will start at Erasmus MC. “Then hopefully people waiting for a heart transplant will also benefit from it,” says Hoek.
In the Netherlands, 60 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 someone registers not to.
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