In Organ Transplants, Cooling Things Down May Not Be The Way To Go

Last year, tens of thousands of organs were removed from dead or dying patients, packed in ice, and raced to an operating room so a very sick patient could get a life-saving transplant. On average, 22 people die every day in the U.S. because they couldn’t get one of those organs. Now, a company and hospital in Massachusetts are teaming up to figure out if there might be a better way to do those transplants, and to save more lives.

Biology professor Lloyd Matsumoto was at a department picnic at Rhode Island College when he first realized he might have a serious health problem.

"A colleague’s wife who is a physician asked me if I had heart disease," he said. "And I said no I didn’t why did you ask? And she said because your legs are swollen, you need to see a physician."

He did, and found out a liver disease he’d been dealing with for decades had led to cirrhosis, and there were now cancerous tumors on his liver, too.  At nearly 70 years old, he needed a transplant.

“A lot of my former students volunteered," he said.  But nobody was a good match for a living donation. So he went on the list to get a liver from a deceased donor. Matsumoto was on the transplant list for a year and a half. Since a lot of transplants happen in New England, there’s a greater demand for organs here, meaning our regional wait list is actually among the longest in the country. As he waited, Matsumoto got sicker and sicker. Jaundice yellowed his complexion and turned the whites of his eyes orange. And then, one of his doctors at Massachusetts General Hospital offered him an opportunity to join a clinical trial.

“She told me about this experiment about using a heating system to heat the liver before it got transplanted into me," he said. "And I said, ‘research, I’m a scientist, hello, I’m going to do it.’"

At his company's headquarters in Andover, Waleed Hassanein showed off a pig’s liver enclosed in a clear case surrounded by electronics. It’s about the size of a small dishwasher, and sits on a cart on wheels.

“It sounds like a heartbeat, because our pump matches, or has been designed to produce the same pulsatility, that the liver or the heart or the lung sees in the human body," he said.

Hassanein is the president and CEO of TransMedics, which created this device to keep donated organs alive. A plastic bag hung off the machine gathers a dark liquid.

“And as you can see here, there's bile accumulating in this bag," he pointed out. "And the bile is very important because it shows that the liver is viable, it’s alive."  The bile is the color of caramel. “Well, the darker it gets, the better quality bile it is," he said, "so this is a good sign."

Usually, when an organ is removed, they cool it down as quickly as possible to slow its metabolism. But Hassanein says ever since he first started training as a transplant surgeon, he thought there must be a better way.

“The minute you take an organ outside of the oxygenated warm environment of the donor body and put it on ice, the organ is immediately decaying," he said. "It’s called ischemic injury. The longer the organ stays in this environment, the higher the probability that the organ will die and it will never function when it’s transplanted.”  

So by keeping it warm, and keeping blood and other nutrients running through it, he said, they can not only prevent that decay, they’re hoping to actually improve the health of the organ. And there’s another way this may be better than just taking an organ out of a cooler.

“The traditional way is sort of a black box,” said Dr. Jim Markmann, chief of the liver transplant surgery division at Massachusetts General Hospital. “We take the liver out and have no idea how it’s going to perform when we put it in.” Markmann said nationally, about a thousand livers a year are discarded because of that uncertainty.

“So if we had a way to assess them during this period of perfusion, to tell which ones work and which ones wouldn’t, we could use a lot more,” Markmann said.

And right there on the TransMedics device is a screen, just like you’d see next to a hospital bed. It’s basically monitoring the organ’s vitals, and telling the surgeons how it’s doing.

There are other companies working on similar technologies. But the FDA is currently considering TransMedics technology for heart transplants, and the company’s hoping to get it considered for lungs soon. In livers, they’re just getting started with MGH’s clinical trial. They’ve used it in three patients so far – one of whom was Lloyd Matsumoto.

Markmann was the surgeon put that liver in Matsumoto. “It reacted beautifully," he said. "Started making bile right away."

Markmann stressed this is still very new and still experimental, so it’s way too early to say whether it works better than the old and cold method, which they’ve been doing successfully for years. But he’s encouraged by what he’s seen so far. And Matsumoto said he’s feeling great.

“It was almost like a miracle," Matsumoto said. "All of these things that could go wrong didn’t. And everything went right."

This coming spring, the 71-year-old is planning on teaching one more semester of introduction to biology, before going on to enjoy his retirement, and the rest of his life.