Organ Care System: treatment under extreme conditions

Multidrug-resistant organisms that are treated with a dosage that exceeds the regular dose a hundred times and at temperatures of over 40 degrees Celsius – the human organism is unable to handle it. Yet if the diseased organ is treated outside of the body, extreme conditions are an option. For the first time, physicians have succeeded in treating a severe case of pneumonia by using the Organ Care System.

In this interview with MEDICA-tradefair.com, Professor Haverich describes the advantages of the Organ Care System, explains how the treatment works and reveals why these types of treatment should nevertheless remain the exception.

Professor Haverich, what exactly is the Organ Care System?

Prof. Axel Haverich: The Organ Care System (OCS) is used for the transport of donor organs – hearts or lungs – from the donor to the recipient hospital, while maintaining a near-physiologic and functioning state. What makes this system so unique is that the respective organ is supplied with blood, meaning it is kept in a living state. This means, a heart keeps on beating during the entire six to twelve hours it takes for transport. This system avoids Ischemia – the inadequate blood supply to an organ – used for the traditional organ preservation process in cold conditions. The system is slightly modified for lungs. During the transport, lungs are not only supplied with blood but also ventilated with oxygen. The OCS is able to maintain a near-physiologic state of the donor organ for many hours.

You were recently successful in treating pneumonia in the OCS. How exactly did you do this?

Haverich: We initially administered this treatment in a large animal model. We used the Pseudomonas aeruginosa bacterium to cause pneumonia in a pig. Common in patients with cystic fibrosis, this bacterium is multidrug-resistant and the only effective antibiotics are no longer clinically approved due to their many side effects. Once this bacterium impacts the patient, it is extremely difficult to treat with antibiotics. We would have had no other treatment options in this case.

The advantage of an OCS is that we can administer a higher dose of the antibiotic to the organ, which would otherwise have severe adverse effects on the liver, kidneys, central nervous system and blood. What's more, we are able to do this at temperatures where the antibiotics work better, at about 40 degrees Celsius. The Organ Care System enables us to treat under extreme conditions without damaging the organism.

How would the preparation process and subsequent treatment in the OCS work for human beings?

Haverich: In the case of lung cancer, we first have to perform surgery and remove the patient's lungs – this is common for lung cancers or in connection with donor transplants. We subsequently set up the organ in the OCS to supply it with blood and oxygen. After we have treated the lungs with chemotherapy or radiation therapy, we can return the organ back to the body. This is also how we proceeded in our animal experiments.

How does the benefit justify the risk of removing the organ from the body?

Haverich: Needless to say, this refers to a high-risk situation – and strictly speaking a situation without any other alternative, where conventional treatment options are ineffective. We would have no clinical or medical ethics constraints in these cases. I think in the future, most patients with an infection will still receive conventional treatment with antibiotics. Having said that, the Organ Care System might be an option for cancer patients because many of them – especially patients with recurrent pulmonary metastases – are difficult to treat. This is where we definitely see a chance for selected patients to treat the organ outside of the body in this type of system.

Where do you personally see a development potential for this type of treatment?

Haverich: I see an enormous development potential as it pertains to the procedure and the technology. However, the number of patients that will be treated via the OCS will remain quite small since the costs and the risk for the patient is simply too high. That is to say, this technique will always pertain to terminal diseases where it presents an alternative treatment option when conventional methods no longer work.

We conduct experiments where we repair coronary heart diseases ex vivo (outside of the body). Prior to bypass surgery, we remove the arteriosclerotic plaque. Once again, we only do this in the case of patients where procedures such as an artificial heart implant are no longer an option. The system is currently also being tested for liver transplantation. A kidney application is also conceivable. Incidentally, lung transplantation with the Organ Care System has also been approved in the U.S. since March of this year.