'Lungs in a box' could increase vital transplants

Royal Papworth Hospital Donated lungs inside a special dome shaped incubator. The dome is plastic and you can see the tubes carrying liquid oxygen and nitrates going into the trachea of the lungs. They are being inflated by a ventilator — The machine, nicknamed “lungs in a box”, is designed to mimic the human body

A new machine which keeps lungs alive outside of the body could “transform” the number of people receiving transplants, surgeons hope.

The breakthrough has come at Royal Papworth Hospital in Cambridgeshire after it became the first in the UK to pilot the use of the XPS system.

The machine, nicknamed “lungs in a box”, mimics the human body and surgeon Marius Burman said it could increase the number of transplants by 30%.

Daniel Evans-Smith, a 49-year-old event manager from Northampton, was the first to receive a double lung transplant using the system on the NHS and said he was “immensely grateful”.

David Evans-Smith had the double lung transplant in the summer and is hoping to return to work in three to six months

Royal Papworth Hospital Daniel Evans-Smith looks at the camera from his hospital bed. He is dressed in a hospital gown with a blanket over his shoulders. He had a beard and greying hair. You can see oxygen pipes in the background which are not attached to Mr Evans-Smith — David Evans-Smith had the double lung transplant in the summer and is hoping to return to work in three to six months

Some 81% of lungs are rejected for transplantation because they are inflamed or in poor condition.

The machine improves the health of the organs, by using a ventilator to inflate and deflate the lungs. A liquid containing nutrients and oxygen is also pumped through them.

The technique is called ex vivo lung perfusion (EVLP). It means donated lungs which are considered “borderline” for use can be reconditioned and used, instead of being discarded.

The organs are kept at body temperature, for up to six hours.

The one-year pilot has been funded by NHS England and the Royal Papworth charity.

The machine was only previously used in UK research trials.

Mr Evans-Smith waited eight weeks for a transplant using the machine. The average wait in the UK is 18 months

Royal Papworth Hospital Daniel Evans-Smith lying on a bed in the operating theatre at Royal Papworth hospital. He has his eyes open and a wristband on and is looking up at the ceiling. A surgeon stands behind him wearing a hair net and scrubs. Two nurses are checking equipment to his left and are wearing scrubs and aprons — Mr Evans-Smith waited eight weeks for a transplant using the machine. The average wait in the UK is 18 months

Prof Derek Manas, NHS blood and transplant medical director, said there was “mounting evidence” the technology could “enable more transplants by improving organ function”.

Despite the law change on organ donation consent in 2019, the hospital said there was a shortage of donated lungs, so the machine was making the most of those available.

Prof Manas said more than 200 people were waiting for a lung transplant which “significantly” outweighed the number of suitable donor organs.

Having the lungs “alive” outside the body also allows surgeons to test the organs, which means the transplants have a better chance of success.

Mr Evans-Smith spent three weeks in the critical care department after his transplant and takes drugs to prevent his body from rejecting the lungs

Royal Papworth Hospital Daniel Evans-Smith sitting in a wheelchair outside Royal Papworth hospital. He is looking at the camera and has two female staff members standing behind him in white uniform. They are wearing face masks. Mr Evans-Smith has an oxygen tube going into his nose and taped to the side of his face. He is wearing a black t shirt and grey jogging bottoms. — Mr Evans-Smith spent three weeks in the critical care department after his transplant and takes drugs to prevent his body from rejecting the lungs

Mr Evans-Smith quit smoking 12 years ago, but developed chronic obstructive pulmonary disease (COPD), a lung condition that causes breathing difficulties.

He suffered a collapsed lung on five occasions and spent a total of six months in hospital before the transplant.

He was about to be discharged when he was woken by nurses who told him donor lungs had been found.

The organs were put on ice and transported to Cambridge, where they were placed in the machine to be “reconditioned” before transplant.

Mr Evans-Smith can now walk up the stairs to his flat thanks to his new lungs

DAWID WOJTOWICZ/BBC Daniel Evans-Smith walking up the stairs to his flat in Northampton. He is holding onto a cream banister and is wearing a green wool jumper and navy cordroy trousers. His beard his slightly plaited and his hair is greying. — Mr Evans-Smith can now walk up the stairs to his flat thanks to his new lungs

Mr Evans-Smith said it was a “privilege to be chosen”.

He said: “There were conversations this time last year, with some of the hospitals saying I needed to talk about palliative care, because if I didn’t get the transplant under way very soon, the likelihood was I wouldn’t survive.”

He is now hoping to fundraise for the team that saved his life.

“I can now do hills without having to think about it, I don’t have to rest when I’m out and about around town,” he said. “I can’t thank them enough”.

Surgeon Marius Berman hopes the positive results of the 12-month pilot will mean funding is continued

NIKKI FOX/BBC Surgeon Marius Berman standing in the critical care department at Royal Papworth Hospital in Cambridgeshire. There are blue curtains either side of him and some monitoring computers in the background which are blurred. he is wearing blue scrubs and has metal rimmed glasses on. He is looking directly at the camera with short greying hair. — Surgeon Marius Berman hopes the positive results of the 12-month pilot will mean funding is continued

Marius Berman, surgical lead for transplantation at Royal Papworth Hospital, said they were “very proud to have become the first UK hospital to use this machine” outside of clinical trials.

Other technology exists, but surgeons said the simplicity of the machine allows people to be trained quickly and some alternatives require a surgical team to travel to the donor, which can be expensive.

He said 30% of people on the lung transplant list died and Mr Evans-Smith had “had a very small window of opportunity”.

“Daniel would not have been with us today without a lung transplant, and we couldn’t have done the lung transplant without EVLP,” he added.

Royal Papworth hospital carries out more lung transplants than any other UK centre, completing 41 in the last year.