The first lung transplant has been successfully completed through the UK's landmark new Assessment and Recovery Centres (ARCs) pilot programme, marking a major milestone in efforts to increase the number of life-saving organ transplants.
The ARCs programme introduces a new model of transplantation in which an organ is donated at one hospital, taken to a second hospital to be placed on a perfusion machine where its function is carefully assessed, and then transplanted at a third hospital.
The donated lungs are perfused outside the body on the XPS machine from XVIVO
Back in March, Royal Papworth was named as one of the first regional perfusion hubs in the pilot, where selected donated organs initially considered difficult to assess or borderline for transplant would be brought here for assessment and treatment.
Developed by NHS Blood and Transplant, in collaboration with the cardiothoracic transplant community, and funded by the Department of Health and Social Care, ARCs is the first national programme of its kind in the world.
It is expected to eventually increase the number of transplants by around 20%, potentially helping save or improve an additional 750 lives every year.
The donor lungs prior to perfusion
The first transplanted lungs were donated at a hospital in the north of England. They were then transported here to Royal Papworth for ex vivo lung perfusion (EVLP) assessment. This is where oxygenated blood and medicines are passed through the lungs, whilst they are ventilated on a special machine - the XPSTM system from XVIVO - to enable testing to take place.
Once confirmed as being suitable for transplant, the lungs were then transported to Queen Elizabeth Hospital Birmingham for a patient on the NHS transplant waiting list.
The donated lungs after perfusion
Not only was this the first set of lungs transplanted in the ARCs pilot, it is also the furthest perfused lungs have ever travelled for transplantation outside North America, creating a new UK and European record.
The recipient is recovering well and has been discharged from hospital.
The ARCs model has been designed to make the best possible use of donated organs by providing transplant teams with more information about organ function before a transplant takes place.
Currently, some organs fall into a clinical ‘grey area’, where initial assessments do not provide enough information to confidently determine whether they are suitable for transplant. Because decisions must often be made within a matter of hours, such organs can be declined out of caution.
Through the ARCs programme, organs can undergo additional functional assessments using machine perfusion technology at the second hospital, which allows clinicians to evaluate suitability for transplant in greater detail. This gives a transplant team at a third hospital greater confidence when considering organs for transplantation. The programme has significant potential to unlock crucial additional transplant activity, particularly for lung patients.
A liver has already been transplanted through the pilot programme, and additional pilot sites, including kidney pilot centres, will launch over the coming months.
If the pilot programme is successful, ARCs could become the standard approach for assessing organs that require further evaluation before transplantation.
In theatres at Royal Papworth, consultant transplant respiratory physician Dr Jas Parmar and transplant consultant surgeons Mr Marius Berman and Mr Pradeep Kaul discuss the donor lungs
The programme builds on over a decade of pioneering work in organ perfusion undertaken by transplant centres across the UK.
By bringing expertise together in a coordinated national programme, ARCs aims to increase access to transplantation, support organ sharing across the country, and establish a consistent national approach to assessment and preservation.
The ARCs programme will have 15 pilot sites, when all are rolled out. If this pilot program is successful and a UK national service created, several dedicated and specialist ARC centres would be created. In the future, there is potential for organs to be treated during machine perfusion to improve their quality and how well they function after transplantation.
Mr Marius Berman, Consultant Cardiothoracic & Transplant Surgeon and Clinical Director for Transplantation at Royal Papworth Hospital, said, “Transplantation is truly transformative and a core activity at Royal Papworth, so we are proud to have played an instrumental part in a wider national cardiothoracic community effort.
“We were pleased to contribute our expertise in ex vivo lung perfusion for this first lung transplant in the ARCs programme. This important milestone reflects years of innovation and collaboration across the transplant community.
“Our hope is that this pilot enables more donor lungs to be safely assessed and transplanted, giving more patients the opportunity to receive a life-changing transplant.”
Some of the Royal Papworth transplant, surgical and theatres teams involved in perfusing the lungs
Mr Andrew Fisher, consultant in severe lung disease and Lung Clinical Lead for the ARCs Programme at NHS Blood and Transplant, said “I am delighted that the first lung transplant has been performed using donor lungs that have had their quality checked in an ARC pilot site before being sent to another transplant centre for a patient on their waiting list.
“All transplant teams now have the ability to ask for donor lungs where there is uncertainty if they can be used, to be sent to an ARC to be tested. It shows the potential for this to increase the number of suitable lungs available for transplant and to make lung perfusion technology available to every patient on the waiting lists across the country.
“The transplant represents not only a significant clinical achievement but is also a celebration of the power of collaboration across the UK's cardiothoracic and transplant community, that has come together to design, launch, and deliver the ARCs pilot programme.
“We should also remember that none of this is possible without the generosity of the donor and all families who support donation. They are lifesavers.”
Mr Aaron Ranasinghe, Consultant Heart and Lung Transplant Surgeon and Transplant Programme Lead at University Hospitals Birmingham NHS Foundation Trust said: “This landmark transplant demonstrates what can be achieved when NHS organisations collaborate in new and innovative ways to make the very best use of donated organs. Through the ARCs programme, expertise from specialist teams across the country can be brought together to assess, preserve, and successfully transplant organs that may previously have been declined.
“For our patients, this represents more life-changing opportunities, and it is an exciting glimpse of the future. By enabling more detailed assessment of donor organs and extending the opportunities for organs to reach suitable recipients, we are honouring the precious gift from donors and their families.”
Minister of State for Health, Karin Smyth, said: “This is a fantastic example of British medical innovation saving lives. I am incredibly proud that the UK is hosting the first national programme of this kind anywhere in the world, giving patients a better chance of a life-changing operation.
“This breakthrough could help save or improve an additional 750 lives every year, and it is a testament to the skill and collaboration of our NHS staff and scientists that the UK is a world leader in this field.
“We are determined to build an NHS fit for the future, one that harnesses cutting-edge science to improve outcomes for patients. This is exactly the kind of innovation that will help us do that.”
The transplant centres acting as ARC pilot sites are:
- Kidney - Cambridge, Newcastle, Oxford, Edinburgh, Royal Free, Manchester, Hammersmith
- Liver -Cambridge, Royal Free, Kings College, Edinburgh, Newcastle
- Lung – Royal Papworth, Newcastle, Harefield.
Other transplant centres may support the pilot in the future. If the pilot is successful, dedicated multi-organs ARC facilities would be created.