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Back Page The University of Florida (UF) Health Shands Transplant Center in Gainesville, FL, US is one of 15 centers in the United States testing a new system that could improve the viability of donor lungs, enabling more of them to be used and shortening the time patients have to wait for transplantation. e system allows donor lungs—about 80 percent of which are found unacceptable for trans- plant under the very high standards required for the organs—to essentially be kept alive and poten- tially improved to become eligible for transplant. e XVIVO Lung Perfusion Sys- tem (XPS™) (XVIVO Perfusion, Gothenburg, Sweden) was ap- proved in 2014 by the United States Food and Drug Adminis- tration (FDA) under the human- itarian device exemption. e approval required that the manu- facturer continue studies to col- lect additional information on the system's use. "We have been working in the lab- oratory since 2010 with our own system and have been looking for- ward to finally seeing the clinical application of the FDA-approved system in the United States," said omas Beaver, MD, MPH, who established UF's work in lung per- fusion. "is is a major advance in the field of lung transplantation." Sustaining lungs for additional evaluation and potential improvement Traditionally, lungs considered for transplant are evaluated once by a surgeon at the medical center of- fering the lungs, while the organs remain inside the donor. Howev- er, the assessments may not pro- vide all information a transplant- ing surgeon needs and conclu- sions about the organs' viability can be difficult to reach. Without convincing proof of excellent lung health, the organs are sometimes rejected because doubt remains about their condition. However, some of the rejected lungs may have potentially re- versible problems, such as pul- monary edema or impaired gas exchange. If those problems can be corrected, the donor lungs could become excellent candi- dates for transplantation. Using the XPS, candidate lungs are treated outside the body with a preservative and oxygen to maintain and potentially improve their health. e lungs contract and expand for hours under nor- mal body temperature, allowing trans plant surgeons to assess them over time. Studies have shown that lungs treated in the XVIVO system and rated acceptable through numerous careful assess- ments are safe for transplant. 1 Increasing the pool of acceptable donor lungs "is technique will help to expand the pool of acceptable donor lungs, hopefully shortening the waiting period for donor lungs and, more importantly, preventing deaths of those whose health condition can- not afford the wait time," said Tia- go Noguchi Machuca, MD, PhD, the lung transplant surgeon who leads UF Health's lung perfusion program and who studied at the University of Toronto, where out- of-body lung perfusion techno logy was pioneered. 1 "With today's increased awareness of lung transplantation as a thera- peutic alternative for many end- stage lung diseases, waiting lists are growing quicker than our abil- ity to offer a transplant with our current donor selection criteria and practice," explained Juan Sal- gado, MD, Medical Director for the UF Health Lung Transplant Program. "Dr. Machuca's exper- tise will allow us to consider an expanded pool of donor lungs to be able to increase our patients' chances of receiving new lungs." Disparities in donation supporters vs. registrants In the US, 118,000 men, women and children are waiting for lifesav- ing organ transplants 2 and 8,000 deaths occur each year because or- gans are not donated in time. 2 New system enables more donor lungs to be transplanted 28 August 2017 Inhalation continued on page 27