Donor lungs travel hundreds of miles between three hospitals in NHS transplant first

A set of donor lungs that might previously have gone unused has travelled hundreds of miles between three hospitals before being successfully transplanted into a patient in a first for a new NHS programme.

The transplant was carried out as part of the UK’s new Assessment and Recovery Centres (ARCs) pilot, which is testing a different approach to assessing donated organs that transplant teams may initially be uncertain about using.

Rather than an organ travelling directly from the donor hospital to the patient waiting for a transplant, the new model allows it to be taken to a specialist centre first, where clinicians can assess how well it functions using machine perfusion technology.

In the first lung transplant completed through the programme, the lungs were donated at a hospital in the north of England before being transported to Royal Papworth Hospital in Cambridge.

There, specialists used a technique known as ex vivo lung perfusion to assess the organs outside the body. Oxygenated blood and medicines were passed through the lungs while they were ventilated on a specialist machine, allowing the team to examine their function in greater detail.

Once clinicians were satisfied the lungs were suitable for transplantation, they began another journey, this time to Queen Elizabeth Hospital Birmingham, where they were successfully transplanted into a patient on the NHS waiting list.

The recipient has since recovered sufficiently to be discharged from hospital.

NHS Blood and Transplant said the case was the first lung transplant successfully completed through the national ARCs pilot programme. Royal Papworth said it also set a UK and European record, with the lungs travelling further after perfusion for transplantation than any others outside North America.

The programme has been developed to address one of the major challenges facing transplantation: deciding whether donated organs that fall into a clinical grey area are safe and suitable to use.

Transplant teams often have only a matter of hours to make that decision. Where initial information does not provide enough certainty about how well an organ will function, it may be declined out of caution.

The ARCs model gives specialists additional time and information by allowing selected organs to be sent to centres with expertise in machine perfusion. If further testing shows the organ is suitable, it can then be transported to another hospital with a patient waiting for a transplant.

NHS Blood and Transplant hopes the approach will mean fewer potentially usable donated organs are lost and will make specialist perfusion technology available to patients regardless of which transplant centre is treating them.

The pilot is particularly significant at a time when demand for donated organs remains high. More than 8,000 people are currently on the UK transplant waiting list, while the availability of suitable organs continues to limit the number of operations that can be carried out.

The ARCs programme will eventually involve 15 pilot sites and include donated lungs, livers and kidneys. A liver has already been successfully transplanted through the programme, with kidney pilot centres also due to launch.

If the approach proves successful and is introduced nationally, NHS Blood and Transplant estimates it could increase the number of transplants by around 20%, potentially allowing up to 750 additional people every year to receive a life-saving or life-improving transplant.

There is also potential for the technology to go beyond simply assessing donated organs. Future developments could allow organs to be treated while connected to perfusion machines, including through surgical repairs and other interventions designed to improve their condition before transplantation.

The ARCs programme, developed by NHS Blood and Transplant with the UK’s cardiothoracic transplant community, is the first national programme of its kind in the world.

Professor Andrew Fisher, Lung Clinical Lead for the ARCs programme at NHS Blood and Transplant, said the first transplant demonstrated the potential to increase the number of lungs available to patients and make perfusion technology accessible across the country.

He also stressed that the programme ultimately depends upon organ donors and their families, whose decisions make transplantation possible.

For the patient who received these lungs, the new system has already demonstrated what that can mean in practice. An organ that may once have been considered too uncertain to use was instead given a more detailed assessment, transported across the country and successfully transplanted.

If the pilot delivers similar results on a larger scale, the journey between three hospitals could become an important part of making sure more donated organs ultimately reach the people waiting for them.

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