9 March 2016
A petite woman with cystic fibrosis has received a life-saving double lung transplant after highly-skilled surgeons at Harefield Hospital combined their expertise to use a pioneering technique to safely ‘downsize’ a pair of donor lungs.
Hayley Wall, 27, desperately needed a transplant after her health deteriorated due to the illness. The inherited condition, which damages the lungs and digestive system, can also lead to poor growth. At just 4ft 8in and six-and-a-half stone, Hayley was told by doctors that her size would make it difficult to find donor lungs small enough to be suitable for a transplant.
The team at Harefield Hospital decided that Hayley’s best chance of survival was a lobar lung transplant. This meant transplanting part of some larger donor lungs into the smaller space available in Hayley’s chest. When suitable donor lungs became available last December, surgeons used revolutionary transplant technology, known as the Organ Care System, to ventilate the donor lungs outside the body while they separated the individual lobes to ensure a perfect fit for Hayley.
This was the first time the Organ Care System 1 had been used as part of a lobar lung transplant in the UK. Conventionally, organs are placed on ice to preserve them while they are transported from donor to recipient. However, with the Organ Care System the lungs are placed in a sealed plastic box containing a pump that provides a constant supply of blood to the organ. A ventilator inflates and deflates the lungs, effectively mimicking the same conditions the lungs would have in the body.
Hayley’s transplant surgeon, Mr Fabio Dr Robertis, explains: "Very petite patients tend to remain on the waiting list for a long period and can sometimes run out of time waiting for organs of the right size to become available. To carry out a lobar transplant, where we remove lobes from each donor lung to match the size of the recipient’s lungs, the donor needs to be significantly taller than the recipient so that the lobe used is as big as the patient’s entire lung.
“When the lungs are placed in the Organ Care System they keep their shape and size, which gives surgeons a good idea of their volume. The donor lungs also sit in the position they would do in the body so it easier to separate the lobes.”
Mr De Robertis combined his specialist skills with those of consultant thoracic surgeon Mr Niall McGonigle to carry out the transplant. Mr McGonigle carries out routine lobectomies, for example on patients with lung cancer, and was able to make the donor lungs the right size for Hayley.
Of the novel surgery, Hayley, who is now recovering well at home, said: “At first I found the concept of donor lungs being cut to fit me quite scary, but I’m amazed by the technology and surgeons’ techniques that allowed it to happen. They saved my life and I can breathe with my new lungs better than ever.”
Dr Keith Brownlee, director of impact at the Cystic Fibrosis Trust said: “Our ‘Hope for More’ report exposed the tragedy that one-in-three people with cystic fibrosis dies waiting for a lung transplant, while around 75 per cent of donated lungs go unused.
“We are delighted that surgeons at Harefield are exploring all opportunities and using innovative techniques to ensure people with cystic fibrosis have access to lung transplants when they need them. There must be a renewed focus on understanding what lungs are suitable for transplant.”
1. Developed by US firm TransMedics