Lung transplantation in India- The cost effective way

The Standard donor lung preservation technique with cold flush and storage allows up to six hours between retrieval of lungs from the donor and transplantation in the recipient. Ex vivo lung perfusion (EVLP) systems mimic physiological ventilation and perfusion in the donor lungs with potential for prolonged lung preservation and donor lung reconditioning.

The present study that I am mentioning here aimed to perform Ex vivo lung perfusion on discarded donor lungs using a locally developed Ex vivo lung perfusion system. The study is published in Indian Journal of Medical Research.

So for the study, equipment that are routinely used for cardiac surgeries were collected and a functional Ex vivo lung perfusion system was assembled. This system was used on five pairs of lungs retrieved from brain-dead organ donors. The lungs were ventilated and pulmonary circulation was continuously perfused with a solution containing oxygen and nutrients for four hours. The system was tested without red blood cells (RBCs) added to the solution and also with RBCs added to the solution.

The Ex vivo lung perfusion system was successfully used in four of the five lung pairs. Mechanical and gas exchange functions of the lungs were preserved in these lung pairs. One lung pair worsened and developed pulmonary oedema.

Histopathological examination of all five lung pairs was satisfactory at the end of the procedure. So the major challenges faced were leakage of solution from the system and obstruction to drainage of RBCs containing solution from the lungs.

The results of the study suggest that, it is possible to maintain the lungs retrieved for transplantation in a physiological condition using a locally prepared Ex vivo lung perfusion system and a solution without RBCs.

Hence, this itself is a revelation and can effectively be put to use.

Reference: Ganesan, Rajarajan1; Kajal, Kamal1; Singh, Harkant2; Das, Ashim3; Kaur, Rajinder4; Saini, Naveen4; Puri, Goverdhan Dutt1,. Development of a cost-effective ex vivo lung perfusion system for lung transplantation in India. Indian Journal of Medical Research: February 2022 - Volume 155 - Issue 2 - p 293-300 doi: 10.4103/ijmr.IJMR_27_19.