Like kidneys, livers are in short supply. So arranging for a transplant is a difficult task. Moreover, while kidneys can remain viable for 24 to 36 hours, that is not the case for livers. They normally must be transplanted or discarded within 8 to 12 hours of removal from the donor.
(The first human transplant involved a kidney, which was transplanted at Brigham and Women’s Hospital [Boston] in 1954. By the 1960s, pancreas, liver, and heart transplants were being effected.)
Which makes this new development so intriguing. Drs. P-A Clavien, RXS DaSilva, BR Burg * (University Hospital [UH] Zurich, U Zurich); P Dutkowsi and B Muellhaupt (UHZurich); M Mueller, D Eshmuminov, LB Borrego,and A Weber (UZurich) along with MJ Schuler, D Becker, M Hefti, PR von Rohr, and MW Tibbit (ETH Zurich) published their astounding findings in Nature Biotechnology.
These folks pioneered a technique whereby a damaged liver- one not viable for transplantation- can be placed in an “incubator” like environment, where it can be repaired over 3 days. At which point, it can be successfully transplanted. The device has been carefully tested using pig livers and damaged human livers- but now they’ve actually transplanted the repaired human liver. It has taken six years for the device to be considered ready to use for transplanted livers.
What is the incubator? It’s a device whereby oxygen and nutrients are pumped (and waste products, including carbon dioxide, are removed) through the liver, using donated blood. The temperature and pressure matches that of the human body. The unit also includes an artificial diaphragm to simulate body motion, which precludes pressure buildup in the liver, which would kill the organ or its cells. The device is claimed to be able to maintain the liver for up to 10 days.
The report describes that a test organ was removed from a 29 y old donor that suffered from sepsis (due to multiple bacterial infections). In addition, the donor was unable to digest food, which further damaged the liver; there also was a lesion on the liver, which would normally cause it to be rejected for transplant purposes.
Had the liver been subject to the normal rules of storage of 8 to 12 hours, a biopsy to discern if the liver had been repaired could never have been effected. But, this unit – which also afforded the researchers the ability to monitor protein and bile production- kept the liver alive long enough to prove it was producing bile and proteins. (Remember, the donor was unable to digest foods, so the liver wasn’t producing those components- yet.) Furthermore, after high dosage antibiotic therapy, the liver was cleared of microbes. And, there was sufficient time to discern that the lesion was harmless (and not cancerous), so no danger to a transplant recipient would be involved.
The liver was inserted into a 62 y old man (who had cirrhosis of the liver and liver cancer). Within 6 days, the transplanted liver had further regenerated in the subject. It also grew to match the size of the recipient’s body.
After a year, the liver was still functional and the lesion had been reduced in size by half.
Over the next year, the team hopes to effect 24 more liver transplants. At that time, FDA and European regulators approval will be sought.
The team is hoping to modify the device to work for other potential organs.
That is amazing! Hopefully this will save more lives.
I’m with you all the way on this, Martha.
That’s fantastic!
I’m intrigued by the device and the procedure, and I’m proud of my fellow Swiss people who came up with the concept!
Organ transplantation is such an important aspect of modern medicine. That’s why I am glad we recently voted on the following (in Switzerland):
As of (insert date in the forseeable future)
“If you do *not* declare during your lifetime that no organs may be removed from you in the event of your death, you automatically become a donor.”
Currently we / our next to kin need to explicitly consent and carry a donor card. Many people, even if they have nothing against organ donation, never took the initiative to register for a card.
I’m all for transplants upon death- as long as the brain scan test is effected. To make sure we really are dead first.
so awesome someone came up with this technology. an incubator is such a great answer. a boy years ago was fortunate enough to have a second liver transplant after his body rejected the first one. amazing stuff
As long as the incubator can keep the organ viable, it certainly is, Lisa.
This could be ground breaking if it’s finally approved and the research usable for other organs and also all over the world.Very interesting
I’m with you- but it certainly will help with the liver transplants at the very least.
Wow Roy, I always learn the greatest things on your blog. That is something that can only get better as they or other medical professionals develop it to the point they can repair other organs. Please keep us posted if you hear of any new developments.
I plan to follow this development and would be honored to share any improvements.