The object in David J. Reich’s gloved hands looked like a deflated football: oblong and dull brown.
It was a human liver, removed more than a day earlier from an organ donor, and under ordinary circumstances it would have been thrown out. The liver had gone too long without oxygen, deteriorating to the point that it was deemed unsafe to transplant.
Reich, head of transplant programs at Hahnemann University Hospital in Philadelphia, was determined to give it new life. He placed the liver in a basin, connected it to tubing, and switched on a pump — delivering a mixture of oxygenated blood, anti-inflammatory compounds and nutrients to the organ. Within minutes, it started to turn pink.
Each year in the United States, more than 2,500 people die while waiting to receive liver transplants or become too sick to undergo the surgery. As with hearts, kidneys, and lungs, there simply are not enough livers to go around. To increase the supply, researchers are pursuing a variety of strategies to rejuvenate “marginal” organs — those discarded because they are decayed, diseased or too old.
Reich, a professor at Drexel University College of Medicine, has high hopes for the pump-like contraption. The technique is called machine perfusion, and it flips a long-accepted practice on its head.
Rather than keep livers on ice to prevent decay until they are transplanted, physicians use such devices to maintain organs at body temperature, with blood and other fluids circulating as they do in a living person.
Lungs, kidneys, and hearts preserved in this manner have been successfully transplanted, and early trials with perfused livers have shown promise — though the method is more costly than cold storage.
Reich is trying an added wrinkle, collaborating with researchers at England’s University of Birmingham and at Massachusetts General Hospital and using an experimental mixture of anti-inflammatory chemicals and growth factors made by Vital Therapies. The startup said early results were inconclusive. But Reich thinks the fluid can help revive donor livers. “These livers suck up oxygen like there’s no tomorrow,” he said. “They’re like a guy in a desert who hasn’t seen water for a few days.”
Regardless of the effectiveness of the mixture, Reich and other physicians have high hopes for the general concept of circulating body-temperature fluid through the organs. Compared with keeping organs on ice, a primary advantage of warm perfusion is reduced inflammation, said David P. Foley, a transplant surgeon with University of Wisconsin Health.
More study is needed. But if Reich and his colleagues prove they can bring these rejected livers back to life, it will mean new life for patients as well.