Aug. 8, 2013
A researcher at The University of North Carolina at Chapel Hill has received a $4 million, three-year grant from the National Institutes of Health to study assessment and transplantation of lungs from victims of sudden death. The National Heart, Lung, and Blood Institute awarded a $4,185,275 clinical trial grant to UNC for the study, which will begin Sept. 1 and will be led by Thomas M. Egan, M.D., M.Sc., principal investigator. Dr. Egan, a thoracic surgeon, is professor of surgery in the Division of Cardiothoracic Surgery, Department of Surgery at UNC.
Dr. Egan, who started the lung transplant program at UNC in 1989, is internationally known for his research on lung transplantation. His research has focused on use of lungs for transplant from patients who have died suddenly, outside the hospital, and have not been on mechanical ventilation. These are known as non-heart-beating donors (NHBDs). Dr. Egan has shown that lungs are still viable after circulation stops because lung cells obtain oxygen after death from air in the air sacs and airways (other organs require blood circulation to obtain oxygen). His lab has perfused and ventilated human lungs outside the body (ex vivo) to determine if they are suitable for transplant; the lab also has worked to show the safety of transplanting these lungs.
If successful, Dr. Egan’s project could greatly increase the number of lungs available for transplant. Currently, solid organs for transplant come primarily from patients who have suffered brain death and have been on mechanical ventilation before controlled circulatory arrest. However, many lungs from these donors cannot be used for transplant because of inflammation or infection during a prolonged interval of brain death. Lungs retrieved from NHBDs may not only be much more plentiful; they may be superior to lungs currently being transplanted from brain-dead donors.
Duke University (R. Duane Davis, M.D., principal investigator for the subaward), Carolina Donor Services, the regional organ procurement organization, and Lung Banks of America, a non-profit oganization, will have subawards on the grant. Wake County Emergency Medical Services, law enforcement, the medical examiner’s office and other government entities have cooperated to ensure the project is successful.
Lungs from the non-heart-beating donors that are found acceptable after ex-vivo assessment will be transplanted at UNC and Duke to patients who have consented to use of the lungs under FDA- and IRB-approved protocols. Outcomes will be compared to patients contemporaneously transplanted with lungs from conventional organ donors. If the trial is successful, it could lead to a broader study at more institutions. The grant is “More and Better Lungs: Ex-Vivo Perfusion of Lungs from Non-Heart-Beating Donors” (NHLBI grant 1 UM1 HL113115-01A1).
– Margaret Alford Cloud, UNC Division of Cardiothoracic Surgery