A man from Northampton has become the first person in the UK to receive a double-lung transplant using a new machine that could improve the number of lungs available for donation and benefit more patients currently waiting for a lifesaving lung transplant.
Daniel Evans-Smith (49) received his transplant at Royal Papworth Hospital NHS Foundation Trust in Cambridge where a surgical team used a technique called ex-vivo lung perfusion (EVLP).
This takes donated lungs which are initially considered marginally acceptable or marginally unacceptable for transplant, reconditions them outside the body in a special machine - the XPSTM system from XVIVO - and can make them suitable for donation.
The donated lungs are perfused outside the body on the XPS machine
Speaking months after his operation, Daniel said: “I feel very privileged to have been offered the opportunity to be in this situation.
“Last year it was discussed that I may soon need palliative care. Without having a lung transplant soon, the likelihood was that I wouldn’t survive much longer.
“I was woken early in the morning to news that a potentially suitable set of lungs had been found and they were going to be put on the machine to assess them.
“It was very sudden but the lungs performed well and the transplant went ahead.
“I can’t thank my donor and their family enough. Even in this short period of time after transplantation, my life has improved from where I was this time last year.”
Daniel before being taken to the operating theatre for his double lung transplant
EVLP is a technique used widely in Europe and the United States but has not yet become common practice in the UK.
Although there have been a handful of EVLP transplants in the UK before, these have largely been limited to clinical trials or have used different machines.
This new machine, and the establishment of a dedicated EVLP programme at Royal Papworth Hospital, is a significant breakthrough in improving lung transplantation in the UK.
Royal Papworth - which carries out more lung transplants than any other UK transplant centre, has the shortest waiting times for people on the lung transplant list and has the best organ utilisation rates - is currently the only UK centre using EVLP for clinical cases. A total of four patients have now benefitted from this technique.
As a former smoker of cigarettes who quit 12 years ago, Daniel had developed chronic obstructive pulmonary disease (COPD), a lung condition that causes breathing difficulties and can worsen over time, limiting normal activities and requiring oxygen.
Daniel suffered a collapsed lung on five occasions between late 2023 and early 2024 and was initially treated at Northampton General Hospital. He was then transferred to Royal Papworth Hospital, the UK’s leading heart and lung hospital, for further assessment and to manage his condition.
Daniel pictured in September 2024 with some of the NHS staff who were caring for him
Placed on the lung transplant list earlier this summer, Daniel was still in the hospital and ready to be discharged home when he was awoken by nurses to the news that suitable donor lungs had been identified.
With ex-vivo lung perfusion, the explanted lungs are placed in ice as normal, but then when they arrive at the recipient’s hospital they are attached to a machine that will perfuse and ventilate the donor organs. This machine mimics the environment of the human body, allowing the lungs to inflate and deflate as normal.
A special fluid maintains the lungs and helps to restore the normal function and allows the donor lungs to be maintained and possibly improved. The lungs can be maintained in this way for up to four hours. This allows a dedicated team of highly trained specialists to complete a detailed assessment and administer short-term therapeutics if required.
If the lungs perform well over at least three hours of testing, they are removed from the system and put on ice for delivery for transplantation.
Daniel underwent his transplant operation, carried out by a multidisciplinary surgical team led by consultant surgeons Mr Marius Berman, Mr Giuseppe Aresu and Mr Pradeep Kaul. After rehab first in critical care and then on the surgical ward, he recently returned home to Northampton to continue his recovery.
Daniel (second left) with transplant doctors, surgeons and nurses, and the XPS machine
Daniel continued: “The transplant has made a huge difference already. I haven't had a cold, chest infection or symptoms that I had been suffering with in previous years so far, which will be down to the quality of the lungs.
"I can already walk further than before, climb hills without thinking about it and I don't have to rest so often.
“The team at Royal Papworth are very supportive. Even outside of my appointment times, they want to know if I've had any kind of colds or infections so they can react as quickly as possible to prevent them becoming problems for my new lungs."
Mr Berman, Surgical Lead for Transplantation at Royal Papworth Hospital, said: “We are very proud to have become the first UK hospital to use this machine for a clinical ex-vivo lung perfusion case, which has helped to provide Daniel with suitable donor lungs. Without this innovation, he may still have been waiting for a transplant today.
“While this marks another important milestone for our lung transplant patients, it also marks a new beginning for Daniel who continues to receive expert care from our multidisciplinary teams.”
Dr Jas Parmar, Transplant Consultant at Royal Papworth Hospital and also Chair of the Cardiothoracic Advisory Group (Lungs), said: “The rapidly changing landscape of UK organ donation has seen a significant shift in the ability to assess donor lungs. Ex vivo lung perfusion (EVLP) allows clinicians to ensure the delivery of high-quality organs to patients on the waiting list.
“We are delighted to be able to offer this opportunity to these very ill patients in need of lung transplantation. We have only been able to do this with the support that we have enjoyed from our trust, NHS England, NHS Blood and Transplant and of course all donor families without whom this work would be impossible. We are always indebted to their selfless act of organ donation.”
Professor Derek Manas, NHS Blood and Transplant Medical Director for Organ and Tissue Donation and Transplantation, said: “We welcome this news and have supported this programme.
“There’s mounting evidence that organ perfusion technologies can enable more transplants by improving organ function. With more than 200 people currently waiting for a lung transplant, this significantly outweighs the number of suitable donor organs. It is vital that we support innovation to improve the chances that these desperately ill patients will get the call they are waiting for.
“We are grateful for the work to improve transplantation technology and techniques but most of all grateful to the patients and families who agree to save and improve lives through organ donation.”
Christoffer Rosenblad, CEO at XVIVO, added: “We are delighted that Royal Papworth Hospital has become the first UK centre to perform EVLP using our XPSTM technology, a reliable and repeatable technique that offers an increase in usage of available donor lungs.
“The implementation of similar EVLP programmes has enabled increased utilisation of donor lungs at transplant clinics around the world. The outcomes with marginal lungs transplanted after EVLP are also similar to those obtained with so called ‘standard lungs’.”
Daniel, pictured in December 2024, is now back to work part-time