New NHS Technique Enables First Life-Saving Lung Transplant for Patient with Previously Unsuitable Organs

A 62-year-old British man has become the first recipient of a lung transplant made possible by a pioneering National Health Service (NHS) technique that revitalizes donor lungs, a development that could potentially save up to 750 lives each year.

Joe McConnell, a carpenter and father of two, was critically ill and dependent on oxygen before receiving the life-saving procedure. The donor lungs, which might typically have been deemed unsuitable due to their condition, were transported between three hospitals while being kept alive and monitored in a specialized "lung-in-a-box" machine. This innovation allowed medical teams to assess and improve the lungs' function, significantly increasing the chances of a successful transplant.

The Royal Papworth Hospital in Cambridge, a leading center for cardiothoracic transplantation, was at the forefront of this pilot study. Officials noted that the lungs traveled further than any previously transplanted lungs outside North America, setting a new record for the UK and Europe.

Traditionally, many donor lungs are rejected before removal because they fall into a clinical "grey area," where specialists cannot definitively determine their suitability. Lungs that are retrieved are typically transported on ice, but their delicate nature means a significant proportion are rejected upon inspection, often leading to last-minute cancellations of life-saving operations. Annually, approximately 17% of individuals on the lung transplant waiting list die before an organ becomes available.

This new program, however, allows lungs to be placed in the "lung-in-a-box" machine, which keeps them functioning with oxygenated blood and nutrients for up to 12 hours. This extended assessment period enables borderline or difficult-to-evaluate lungs to be potentially rejuvenated and deemed suitable for transplantation, offering renewed hope to patients on the waiting list.

McConnell, who hails from Newport, South Wales, received his transplant at the Queen Elizabeth Hospital in Birmingham. He had been diagnosed with idiopathic pulmonary fibrosis, a condition that causes scarring of the lungs and would have been fatal without the operation. Ten weeks after the surgery, McConnell reports feeling "fighting fit" and no longer requires oxygen support. He is now able to go on walks with his wife and their dog.

The technique employed, known as ex vivo machine perfusion (EVLP), has been utilized in UK hospitals for assessing organs like hearts, kidneys, lungs, and livers. Fifteen hospitals in England, including Royal Papworth, are equipped with these perfusion machines, which simulate the human body's environment and keep organs functioning. More than half of the lungs assessed using this method are transplanted, a success rate double that of lungs transported on ice.

In McConnell's case, the donor lungs were retrieved at a hospital in the North of England and transported to Royal Papworth in a perfusion machine. The machine provides a warm, nutrient-rich solution and ventilation to maintain the organ's viability outside the body. After the detailed assessment at Papworth, the lungs were transported to Birmingham for McConnell's surgery.

This procedure is part of the Assessment and Recovery Centres (ARCs) program, developed by NHS Blood and Transplant (NHSBT) in collaboration with cardiothoracic transplant teams and funded by the Department of Health and Social Care. If successful, ARCs could become the standard for assessing donated organs requiring further evaluation, potentially enabling up to 750 additional transplants annually.

Marius Berman, Consultant Cardiothoracic & Transplant Surgeon and Clinical Director for Transplantation at Royal Papworth Hospital NHS Foundation Trust, explained that EVLP addresses the challenge of making quick decisions on donor lung suitability with often incomplete information. "Potentially transplantable lungs may therefore be declined because of uncertainty on how suitable they are," Berman stated. He added that the development of ARCs aims to overcome barriers such as equipment availability, trained personnel, operating theatre capacity, and logistical challenges through a coordinated national service.

Royal Papworth Hospital established its clinical EVLP transplantation program in 2024 with NHS England funding, providing the infrastructure and expertise for the ARCs pilot. The hospital has played a significant role in the national program, working with other lung transplant centers to improve both the volume and equity of lung transplantation access across the UK.