Volume, Outcomes and Cost of Patient Care
Have Potential for Improvement
Lung transplantation programs world-wide face a number of daunting challenges regarding transplant volume, patient outcomes, and cost of patient care.
Demand Exceeds Transplant Volume
Lung transplantation is widely considered the only cure for many end-stage pulmonary diseases. Patient demand for lung transplantation is strong and the current procedural volume is insufficient. The waiting lists represent only a small fraction of the true demand, and transplant programs cannot provide lungs to all patients who would benefit from the procedure. The situation will grow worse in the future as demand for lung transplantation grows.
Outcomes Can Be Improved
For those patients with the good fortune to receive a lung transplant, the survival and quality of life benefits are substantial. However, the procedure is not without risks. Post-transplant mortality and complication rates are significant and have the potential for marked improvement. Lung transplantation long-term survival rates lag behind other solid organ transplants.
Delayed Treatment and Complications are Costly
Increasing transplant volume and improving patient outcomes would lighten a significant financial burden on the healthcare system. The costs of managing patients who have been turned away from lung transplantation, treating critically-ill patients awaiting lung transplantation, and caring for patients recovering from post-transplant complications are staggering.
Cold Static Storage Method is Limiting
One of the factors contributing to these difficulties is the current method of organ preservation: cold static storage. In this method, a donated lung is cooled, inflated, and held in a static state on ice between the Donor site and the Recipient site.
Number of Retrievable Lungs is Constrained
Cold static storage significantly limits the number of lungs that can be retrieved for a safe transplant. Despite the desperate need for organs, lungs from only 2 of 10 organ donors are ever transplanted. Utilization of donor lungs is so low in part because of the inability of the cold static storage approach to recondition and assess the organ's suitability for transplantation and to adequately preserve the organ:
- Questionable Suitability, but Potentially Recoverable: Potentially recoverable lungs cannot be reconditioned and assessed under cold static storage and, as a result, such lungs often go unutilized.
- Distance: Even with the use of jets and helicopters to accelerate transport, the lung retrieval range is still limited because cold static storage cannot adequately preserve the organ for a sufficiently long time.
Lung Quality and Function Can Deteriorate
Cold static storage can also allow quality & function of donated lungs to deteriorate before they are transplanted into a Recipient.
- Cold Ischemia: The damaging effects of cold ischemia can become permanent between the Donor and Recipient sites.
- Static Inflation: Static inflation has its own limitations in that it does not allow for further recruitment between Donor and Recipient. This may allow the clinical condition of the lung to deteriorate over time and thus have a detrimental effect on the patient.
Fortunately, an alternative preservation method with the potential to overcome these challenges is commercially available in Europe and Australia.