Yes. A single lung can be perfused on the XPS.
Yes. Get working on finding a source of Perfadex right away. If donor happens to be at a lung transplant center your team can likely source some from there, if not check with the OPO and see if they can provide Perfadex or can source some locally.
Also have the heart team be sure that the OPO has lung labels available; they may need to have some brought from their OPO office. If the office is far away the printed OPTN label has all of the required information printed on it. Discuss options with the OPO as they are responsible for the labeling per OPTN policy 16.2.
Yes, there are a couple of scenarios for splitting of the lungs
- If the lungs arrive to LBE and one of them appears to be in a condition not conducive to EVLP the Specialist may contact you and LBE’s on-call Consultant to discuss if the lungs should be split before going on EVLP.
- If the lungs are on EVLP and one lung is performing poorly but the other seems to be doing better, it is possible to split the lungs while perfused. If this occurs, the airway leading to the lung to be excluded is stapled or clamped and the pulmonary artery leading to the lung being excluded is tied off. The lung remains in position until the end of the procedure when it will be completely separated on the backtable.
- If the lungs will be heading to two separate recipients, LBE is able to split the lungs post EVLP and package them separately. We are limited by the amount of blood and tissue typing materials provided with the organ which will be discussed at the time of splitting.
Packaging of the lungs is regulated by OPTN policy 16.3. Please note that the policy specifies the organ must be shipped in a disposable shipping box, a cooler can only be used if a member of the recovery team accompanies the organ. The box used for lungs is typically the same type of box OPOs use for livers.
ACIN is the AOPO Credentials Information Network. All surgeons who perform organ recoveries in the USA must be listed in this database along with the organs they are credentialed for. The credentialing for a surgeon is handled by their local OPO, if you need to confirm that a surgeon is credentialed to recover lungs or to learn more about ACIN, please contact your local OPO or the OPO where the donor is located.
The transplant center and/or OPO are in charge of arranging air and donor/transplant hospital local ground transportation and LBE is responsible for ground local transportation to and from the EVLP facility. If for whatever reason transportation arrangements cannot be made expeditiously, Lung Bioengineering is able to assist in air and ground transportation logistics. An EVLP Specialist contacts the appropriate transplant center personnel to ensure that lungs are imported and exported as quickly as possible. The air and/or ground transportation cost involved with the import of lungs to LBE facilities from the donor location are paid for by LBE regardless of EVLP outcome to transplant. Air and/or ground transportation cost for exporting lungs to an accepting transplant center are also paid by LBE. For reimbursement of transportation costs, LBE must be aware of the method of transportation in advance of any lung import/export activity, and the cost to be paid by LBE must be reasonable.
The EVLP fee paid to Lung Bioengineering includes all expenses from the time the organ gets on the ambulance at the donor hospital until it arrives at your transplant center. This includes the cost of getting the organ to the Lung Bioengineering facility (reasonable ground and air transport), cost of professional services related to the EVLP of the organ, all supplies, all laboratory testing, consultation with Lung Bioengineering’s EVLP consultants, and the cost of getting the organ to your transplant center if it is accepted for transplant (reasonable ground and air transport). The fee does not cover getting your recovery team to and from the procurement or the organ acquisition fee charged by the donor OPO.
Yes, please reach out to info@lungbioengineering.com for assistance in obtaining those materials for your center.
REIMBURSEMENT GUIDEThe transplant center and/or OPO are in charge of arranging air and donor/transplant hospital local ground transportation and LBE is responsible for ground local transportation to and from the EVLP facility. If for whatever reason transportation arrangements cannot be made expeditiously, Lung Bioengineering is able to assist in air and ground transportation logistics. An EVLP Specialist contacts the appropriate transplant center personnel to ensure that lungs are imported and exported as quickly as possible. The air and/or ground transportation cost involved with the import of lungs to LBE facilities from the donor location are paid for by LBE regardless of EVLP outcome to transplant. Air and/or ground transportation cost for exporting lungs to an accepting transplant center are also paid by LBE. For reimbursement of transportation costs, LBE must be aware of the method of transportation in advance of any lung import/export activity, and the cost to be paid by LBE must be reasonable.
Lungs should be packaged according to OPTN policy for unaccompanied organs and include tissue typing material and blood.
To purchase insulated containers for shipping, please visit https://www.fishersci.com/ (item number is SG-9W)
The OPTN policy can be accessed at the following address: https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf
EVLP begins once lung perfusion starts on the EVLP circuit. The EVLP procedure runs for a minimum of 3 hours up to a maximum of 5 hours.
Yes. It is possible for two lungs from a single donor to be sent for EVLP en bloc at LBE facilities, separated and sent to intended recipients at two different transplant centers.
If EVLP demonstrates that the lung(s) are suitable for transplantation and the requesting center declines them, the host OPO will be notified. There are circumstances when the OPO will have the option to place the lungs with another partner program. All allocation is to be completed by the host OPO. Lungs that are not approved for transplant are referred back to the organ procurement organization for final disposition.
From the time LBE receives notification from the transplant center to begin cooldown, it takes approximately 35-40 minutes to get the organ out the door, into the awaiting ground transportation.
From LB1- Silver Spring, Maryland to the local FBO, ground time is approximately 30 minutes. After that, factor in-flight time to your airport, ground time to your hospital, the time to get the lung up to your OR, and bench and implant times before the first lung is reperfused to get a total CIT2.
From LB2- Jacksonville, Florida, to the local FBO, ground time is approximately 15 minutes. After that, factor in-flight time to your airport, ground time to your hospital, the time to get the lung up to your OR, and bench and implant times before the first lung is reperfused to get a total CIT2.