That’s why EVLP is seen as a potential solution, according to Lung Bioengineering. During the procedure, the specialists begin by prepping the lungs for reperfusion—the process of pumping fluid through the blood vessels—and oxygenation. They first suture clear tubing to the piece of the large blood vessel that normally carries blood from the heart to the lungs to obtain oxygen. The team then attaches another piece of tubing, this one shaped at one end like a small funnel, to the four pulmonary veins. Both tubes are connected to a machine that will mimic the heart by pumping fluid through the lungs. Finally, the specialist places a breathing tube into the small portion of the airway left in place by the surgeons who removed the lungs and connects it to a mechanical ventilator, the same type of machine that likely kept the donor alive until just before the removal of the lungs.
Instead of blood, the tubes carry Steen Solution, a protein- and oxygen-rich fluid developed by a Swedish physician specifically for EVLP. Setting up the lungs on the EVLP system typically takes about 40 minutes, but it’s the next hour that’s the most critical.
As the Lung Bioengineering team slowly begins to increase the flow of the Steen Solution and the temperature of the lungs, the specialists begin assessing the organs. With the lungs sitting under a clear plastic dome, rhythmically expanding and contracting with each simulated breath, the specialists periodically measure the levels of oxygen and carbon dioxide in the Steen Solution, which tells them how well the lungs are exchanging gases. During this time, they perform bronchoscopies by inserting a flexible camera into the airways to check for fluid or damage. They also take X-rays that provide clearer pictures than the images taken when the lungs were still in a body where ribs and other organs potentially obscure the view.
“I tell my patients, ‘I’ll know more about that donor lung than I’ll ever know about a lung that we don’t put on [EVLP],’ ” says Dr. Bartley Griffith, director of the cardiac and lung transplant programs for the University of Maryland School of Medicine in Baltimore, one of more than a dozen sites partnering with Lung Bioengineering as part of the clinical trial. “We have a much better look at that organ than one that’s in a human patient.”
During the EVLP procedure, transplant surgeons can log in on a phone or other device and view the results of every test that’s conducted. They also can see the lungs and talk to the specialists in the room via a system resembling FaceTime. The team in the operating suite can move a set of cameras to provide surgeons with the views they need to make their decision.
“There clearly is a wow factor—the first time you see it, you can’t believe it,” Griffith says of observing the procedure. Part of the genius of Lung Bioengineering, he says, is its plan to create specialized centers that focus on EVLP alone, allowing its teams to improve clinical expertise and economic efficiency in ways that might not be possible at centers where the procedure is performed occasionally. The University of Maryland Medical Center in Baltimore, for example, had its own EVLP program, but shut it down after the doctor who ran it left for another position. At the time, the volume of cases was relatively low.
“We don’t know [the full potential]” of Lung Bioengineering’s model, Griffith says. “But it’s brilliant. And what’s good for the lung could be good for the kidney or liver.”
Like many of her colleagues at Lung Bioengineering, specialist Erin Larrabee does not have a formal medical education. She first learned about the company through her mother, Pat Larrabee, president of Burtonsville-based consulting firm Facility Logix, which helped Lung Bioengineering set up its facility. At the time, the Paint Branch High School graduate was studying biology at St. Mary’s College of Maryland and considering applying to physician assistant school; she worked part time sourcing and stocking some of the same equipment she now uses in the operating rooms.
Fascinated by the little she knew about Lung Bioengineering, Larrabee researched the company and decided almost immediately that she wanted to be involved. In 2014, she became one of its first interns, and soon after she was hired full time as an EVLP technician. More than five years later, Larrabee has moved into the specialist role, the first employee at Lung Bioengineering to do so without any significant health care or organ procurement experience, according to the company. While Lung Bioengineering’s EVLP specialists aren’t required to have specific degrees or professional certifications, all have taken basic college-level science courses, and some have health care experience.