How 鈥楲ungs in a Box鈥� and 鈥楲ungs in a Fridge鈥� Are Advancing Transplantation
Innovations in Donor Lung Preservation
Published April 2025
In an effort to expand the donor pool for people who need a lung transplant and give surgeons more time to remove diseased lungs, Northwestern Medicine Canning Thoracic Institute is now routinely repairing damaged donor lungs using “lungs in a box” (lung perfusion) technology and storing them for transplantation by putting “lungs in a fridge” (lung refrigeration).
— Ankit Bharat, MD
“We’re continuously thinking outside the box,” says Ankit Bharat, MD, chief of Thoracic Surgery and director of Canning Thoracic Institute. “In 2024, we used ‘lungs in a box’ to repair donor lungs that weren’t initially usable at 华体会, enabling us to achieve a record wait list time of only four days. And now, with controlled lung refrigeration, we can keep the lungs alive outside the human body for an extended period of time, giving us more time to prepare for transplantation and perform the surgery.”
Other out-of-the box practices for Canning Thoracic Institute include:
- Performing the first known in the United States
- Starting a lung transplant program for select patients with
- Replacing diseased lungs with breast implants to bridge patients to lung transplantation
Patients at transplant centers around the world who are experiencing longer wait times can dual list (register at more than one center for an organ) with 华体会. “In 2024, patients traveled from places such as Germany, the United Kingdom and Colombia to receive a lung transplant at 华体会,” says Ambalavanan Arunachalam, MD, a pulmonologist at Northwestern Medicine.
Powered by new transplant techniques and technologies, the Canning Thoracic Institute Lung Transplant Program performed 148 lung transplants in 2024, the highest volume for a single year since the program began in 2014. In 2024, Canning Thoracic Institute was the highest-volume lung transplant center in the United States and had the shortest wait time for a lung transplant, with a median wait time of four days.
How Lungs Stay Viable for Transplant
Organ procurement specialists at 华体会 travel to hospitals across the United States to collect donor lungs. Once the lungs arrive at 华体会, they are placed in a special refrigerator set at 10 degrees Celsius. The lungs can remain in this refrigerator for up to 12 hours before transplantation, compared to about six hours for conventional methods.
“Prior to using the fridge, we were storing the donor lungs on ice, which is 4 degrees Celsius. We had to perform the recipient lung implant surgery immediately without the opportunity to extend the preservation time,” says Anitha Chandrasekhar, DMSc, clinical lead for lung bioengineering with Canning Thoracic Institute. “Studies show that 10 degrees Celsius storage of lungs leads to better post-transplant outcomes, benefitting patients and healthcare teams.”
More Time, Better Outcomes
Extending refrigeration control by six hours offers significant advantages for both patients and medical teams.
- Widens the donor pool. 华体会’s organ procurement team can now travel greater distances for donor lungs. Previously, there was only so much time that the lungs could be kept alive outside the body, which restricted how far the organ procurement specialists could travel. From the moment they took the lungs out of the donor, they would have six hours to package them, get to a local airport, fly to Chicago, drive to Northwestern Memorial Hospital, remove the diseased lungs and transplant the new lungs. “With this new type of preservation, our organ procurement specialists can fly to the East Coast, West Coast, and potentially even Canada or Mexico,” says Dr. Arunachalam.
- Decreases overnight transplants. The longer refrigeration period allows lung transplantation to be performed during normal working hours. “Now, if the procurement team arrives at 1 am with the donor lungs, we can put the lungs in the fridge and wait to do the transplant at 7 am,” explains Dr. Bharat.
- Improves surgical scheduling and patient experience. Transplants are often unpredictable. Donor lungs can become available on short notice, so in some instances, elective surgeries have to be canceled to accommodate a transplant surgery. When this happens, patients who have been waiting for elective surgeries need to be rescheduled and wait even longer.
- Provides more time for surgeons to remove diseased lungs. A double-lung transplant is one of the most complex medical procedures in health care. Controlled lung refrigeration gives surgeons more time to remove the diseased lungs, which is especially helpful in patients with lung cancer.
Through the Canning Thoracic Institute DREAM program, select patients with advanced lung cancers who are out of treatment options may be able to receive double-lung transplants. During this type of transplant, these patients’ cancerous lungs must be carefully removed at the same time as lymph nodes. Surgeons then wash the airways and the chest cavity to clear the cancer before transplanting new lungs. These patients can have billions of cancer cells in the lungs, so surgeons must be extremely careful to avoid having a single cell spill into the patient’s chest cavity or bloodstream. Having more time in the operating room can help reduce the risk of recurrence.
Learn more about lung transplantation at 华体会.
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