Organ perfusion is a technique that keeps donated organs usable for transplantation by means of a machine. The technique can increase the number of donor organs available for transplantation and improve their quality. However, organ perfusion is not yet reimbursed. “We hope that the government will approve the reimbursement of organ perfusion, so that we can further expand the method and help even more patients,” says Professor Dirk Van Raemdonck, lung surgeon at University Hospitals Leuven and chair of the Transplantation Council.

According to the latest figures for Belgium (March 2016), 1,270 people are waiting for a new organ. Last year, that organ was not available in time for 112 of them. Organ perfusion can decrease the number of deaths among those on the waiting list. The number of lung transplants, for instance, could increase by an estimated 10 percent.

The standard preservation method for donor organs is cooling on ice. However, if an organ is preserved this way for too long, it may sustain damage due to oxygen deprivation. The organ perfusion method, by contrast, involves placing the organ in a machine prior to transplant surgery. This machines simulates the conditions of the human body. The organ is infused with a solution of oxygen and nutrients via small tubes. In Belgium, kidney perfusion has already been in use for a number of years. University Hospitals Leuven is the only Belgian hospital to also perform lung and liver perfusion in a research context. In the near future, University Hospitals Leuven will also launch a study into heart perfusion.

Longer preservation time

Organ perfusion offers significant advantages compared with standard preservation on ice. It enables surgeons to better assess the condition of the organs and improve their quality. Professor Dirk Van Raemdonck explains: “When someone dies, fluid may accumulate in the lung tissue. With perfusion, you can drain that fluid and transplant the lung – if, of course, it meets the necessary quality standards. As of recently, a heart that’s stopped after the donor’s death can also be restarted in controlled conditions. In other words: organs that we wouldn’t have transplanted in the past because they had sustained a little damage, can become usable again thanks to perfusion.”

Furthermore, perfusion makes it possible to preserve organs for a longer amount of time. On ice, donor lungs stay usable for about eight hours. Lungs in the perfusion machine can be preserved for up to twelve hours, without a decrease in quality. Professor Van Raemdonck: “Transplant surgery with an organ kept on ice is always an urgent procedure, because the preservation time is limited. If it takes too long, the organ may be lost and the patient’s life may be in danger.”

“Due to the increased preservation time, organ perfusion gives us the option to schedule transplant operations during the day, as part of the hospital’s ‘regular’ surgery schedule. As a result, we can count on the presence and support of all specialized medical and nursing staff needed to provide the best possible care.”

Fewer deaths

Although organ perfusion yields excellent results, it’s still difficult to make it the standard preservation method. Professor Van Raemdonck: “Organ perfusion is an expensive technique that costs the hospital a couple of thousands of euros per procedure. However, organ perfusion can also be cost-reducing, as a cost-benefit analysis for kidneys has already shown. An increased number of donor organs and their improved quality may reduce the waiting period for new organs, which in turn limits the duration of expensive treatments such as kidney dialysis. The duration of patients’ stay in the hospital, too, may be reduced.”

Professor Van Raemdonck: “We hope that the government will approve the reimbursement of organ perfusion, so that we can further expand the method and help even more patients. Organ perfusion could be a major change in the world of transplantation. It may result in larger numbers of donor organs of better quality and in reduced mortality rates among those on the organ waiting list. As a result, the number of lung transplants may increase by an estimated 10 percent. A cost-benefit analysis for lungs is still being conducted, but we’re almost sure that organ perfusion can be cost-reducing in that field as well.”

On the left: donated lungs before perfusion. The lungs have accumulated fluid right before the donor’s death. On the right: donated lungs after perfusion. The lungs with fluid were drained for 4,5 hours in the perfusion machine. Afterwards, they were transplanted successfully.
© University Hospitals Leuven

Source: University Hospitals Leuven. Translated by Katrien Bollen.