The first patient in the UK has successfully received a double-lung transplant using a machine that is being nicknamed “lungs in a box”. The XPSTM system from XVIVO could improve the number of available lungs for donation, helping those currently waiting for the life-saving procedure.
The patient, 49-year-old Daniel Evans-Smith, underwent this procedure at the Royal Papworth Hospital NHS Foundation Trust in Cambridge, UK. The technique is called ex-vivo lung perfusion (EVLP); this takes donated lungs that may be classed as marginally acceptable/unacceptable and reconditions them outside the body, making them ready for donation.
“I feel very privileged to have been offered the opportunity to be in this situation,” Evan-Smith explained months after the procedure in a statement. “Last year it was discussed that I may soon need palliative care. Without having a lung transplant soon, the likelihood was that I wouldn’t survive much longer.”
What is EVLP?
EVLP is an innovative therapy that is used widely in the United States and Europe, but not commonly in the UK. This procedure is a significant breakthrough in the improvement of lung transplants in the UK, and Royal Papworth is currently the only UK center that is using EVLP for clinical cases– in a few previous cases, it had been used in clinical trials or with other machines.
Once removed from the donor, the lungs are placed in ice. When they arrive at the recipient’s hospital, they are attached to the machine, which perfuses and ventilates the donor organs and helps mimic the human body, with the lungs inflating and deflating as usual.
A special fluid is used to maintain the lungs and help the restoration of normal function. This allows the donor lungs to be maintained and even potentially improved. The lungs can be maintained for up to four hours, allowing any required short-term therapeutics to be administered and complete a detailed evaluation to be carried out. If the lungs perform successfully over three hours, then they are put on ice for transplantation.
Daniel’s new lungs sit in a cool box in the operating theater, awaiting implantation.
Image Courtesy Of Royal Papworth Hospital NHS Foundation Trust.
“The rapidly changing landscape of UK organ donation has seen a significant shift in the ability to assess donor lungs. Ex vivo lung perfusion (EVLP) allows clinicians to ensure the delivery of high-quality organs to patients on the waiting list.” Dr Jas Parmar, Transplant Consultant at the Royal Papworth explained.
The breakthrough case
Evans-Smith had developed chronic obstructive pulmonary disease (COPD), a condition that causes breathing difficulties and limits normal activities. He had experienced a lung collapse five times during late 2023 and early 2024.
He was placed on the lung transplant list in the summer – and while he was still in hospital and ready to be discharged, he was woken by a nurse who gave him the news that suitable donor lungs had been identified.
His transplant operation was successful, and once the transplant was completed, Evans-Smith underwent rehab and then he returned home for recovery.
Patient Daniel Evans-Smith pictured in September 2024 with some of the NHS staff who were caring for him.
Image Courtesy Of Royal Papworth Hospital NHS Foundation Trust.
“The transplant has made a huge difference already. I haven’t had a cold, chest infection or symptoms that I had been suffering with in previous years so far, which will be down to the quality of the lungs,” Evans-Smith said. “I can already walk further than before, climb hills without thinking about it and I don’t have to rest so often.”
In the UK, there are many people on the lung transplant waiting list, which outweighs the number of donor organs that are suitable. New technologies like this could improve these patients’ chances.
