Additionally, the expanded use of ex vivo lung perfusion (EVLP) systems has effectively decreased transplant wait times by increasing organ availability. These systems enable the resuscitation, preservation, and possible reconditioning of an organ prior to transplantation. “The incorporation of EVLP systems into our clinical practice has enabled us to travel farther to procure organs. It also allows us to be more aggressive in evaluating and reconditioning marginal organs to make them suitable for transplantation,” explains Dr. Dhillon.

The program was recently the first in the nation to utilize the TransMedics Organ Care System (OCS) to obtain, preserve, and transplant a single donor lung. The OCS allows donor lungs to be maintained in a near physiologic state for transplantation. In this case, the Stanford team obtained the youngest donor lungs ever recovered using the OCS and sustained them until successful transplantation.

“These successes highlight both our capacity to address patients in dire circumstances and readiness to ensure the availability of organs to those in need.”

Relatively few centers are equipped to perform transplants involving patients requiring advanced life support, such as extracorporeal membrane oxygenation (ECMO). Dr. Dhillon explains that one unique aspect of their program is the ability to execute these procedures on high-risk patients. Although the COVID-19 pandemic complicated both the performance and availability of such procedures, he notes that their program leads the nation in performing transplants to address COVID-related advanced lung diseases. These efforts include successful completion of the first multi-organ transplant in a COVID patient in 2021. This lifesaving endeavor involved managing the patient’s transport while on ECMO to Stanford for the procedure.

Additionally, the expanded use of ex vivo lung perfusion (EVLP) systems has effectively decreased transplant wait times by increasing organ availability. These systems enable the resuscitation, preservation, and possible reconditioning of an organ prior to transplantation. “The incorporation of EVLP systems into our clinical practice has enabled us to travel farther to procure organs. It also allows us to be more aggressive in evaluating and reconditioning marginal organs to make them suitable for transplantation,” explains Dr. Dhillon.

The program was recently the first in the nation to utilize the TransMedics Organ Care System (OCS) to obtain, preserve, and transplant a single donor lung. The OCS allows donor lungs to be maintained in a near physiologic state for transplantation. In this case, the Stanford team obtained the youngest donor lungs ever recovered using the OCS and sustained them until successful transplantation.

“These successes highlight both our capacity to address patients in dire circumstances and readiness to ensure the availability of organs to those in need.”

To demonstrate the efficacy of therapeutic interventions, clinical trials require relatively large numbers of patients. However, the limited number of lung transplants undertaken annually, even by the largest programs, precludes the conduct of such trials at individual centers. 

As a result, the Cystic Fibrosis Foundation and National Institutes of Health have formed consortia of lung transplant programs. The goal is to drive research and innovation, standardize protocols, and share best practices by pooling resources. As a member of both consortiums, the Heart-Lung and Lung Transplantation Program actively participates in multiple areas of collaborative research.

One area involves suppression of the host immune response, which is a central aspect of post-transplant protocols to avoid graft rejection. However, lung transplants present a complicating factor. “The lungs are the only organs exposed to the outside atmosphere with every breath and the entire blood circulation,” says Dr. Dhillon. This exposure renders them uniquely vulnerable to immune activation and complications related to graft-versus-host disease (GVHD).

To address this, the program is participating in a clinical trial to assess the effectiveness of an inhaled immunosuppressive regimen. This intervention addresses issues observed with oral treatments, which show limited efficacy, significant toxicities, and increased risk of secondary infections.

Additionally, Dr. Dhillon explains that lung transplants eliminate the supply of oxygenated blood to the lungs. If lungs experience future damage, this absence prevents normal healing and leads to scar tissue formation, which can decrease lung function and hasten graft failure. Research by Mark Nicolls, MD, professor of Pulmonary and Critical Care Medicine, Stanford Medicine, is identifying alternative methods of improving airway function and oxygenation to enhance long-term graft survival.

“The need for collaborations focused on improving transplant outcomes has long been understood and accepted in this field,” says Dr. Dhillon. “We are happy to be actively engaged in such partnerships and research to support these goals.”

The distinctive capabilities of Stanford Health Care’s Heart-Lung and Lung Transplant Program underlie the motivation toward outreach to underserved communities. Dr. Dhillon emphasizes the importance of providing access to patients in areas lacking the necessary infrastructure. “There’s a lack of specialized pulmonary care in many communities, so we try to address this by establishing outreach clinics and partnerships with physicians in these areas.”

These clinics offer patients unable to travel an opportunity to be evaluated as potential candidates for transplantation. Patients meeting the criteria undergo remote pre-transplant testing and transport to the main campus for the procedure once an organ is available. We then coordinate remote post-transplant assessment at outreach clinics closer to the patient’s local community. Outreach clinics are currently available in San Jose, California and Henderson, Nevada, with projected locations being established along the central coast of California and southern Oregon.

“Our goal is to provide access to transplants for patients that would not otherwise have the capability to undergo screening,” explains Dr. Dhillon. “Our program is fully committed to these outreach efforts and maintaining open lines of communication with these communities. We have a track record of success in performing complex transplants to save lives and want to make this available to as many patients as possible.”

Learn more about Stanford Health Care’s Lung Transplant Program. For patient referrals, please contact Ryan Leonelli, Market Outreach Executive Liaison, Solid Organ Transplant:

• Cell: 650-670-2190
• Fax: 650-736-3566
• Email: rleonelli@stanfordhealthcare.org

Top image of Dr. Patpilai Kasinpila, Dr. Saverio La Francesca, Dr. John W. MacArthur, and Dr. Irmina Elliott (left to right) inspecting donated lungs prior to transplantation. Photos courtesy of Winston L. Trope.