Machine keeps lungs 'alive' outside the body

Corrections & Clarifications:An earlier version of this story incorrectly stated where the XPS machine was developed. It is manufactured by Sweden-based XVIVO Perfusion.

DETROIT — The medical marvel that saved Kyle Clark's life is about as fantastical as any story the comic books superfan could conceive.

A new machine offered at the University of Michigan keeps donor lungs "alive" outside the human body for up to six hours. That gives doctors critical extra time to inspect the lungs as the machine pumps special fluid through them, essentially "reconditioning" them for transplant, said Dr. Paul Lange, the medical director for Gift of Life Michigan.

He calls it a "game changer" that will preserve lungs that might otherwise get thrown away as unusable.

"People die every day on waiting lists for transplants," he said.

Clark, 25, of Imlay City, Mich., was the first in Michigan to get lungs from the new XVIVO Perfusion System — XPS, for short. He jokes it might be more believable to tell people a charging bear slashed open his chest. Reality, he said, is "like something out of science fiction."

Clark was born with cystic fibrosis, a genetic condition that triggers mucus buildup in the lungs and other organs. That not only makes it difficult to breathe and digest food, it can lead to infection, lung failure and early death. Life expectancy varies, depending on the severity of the disease in each person.

He can finally breathe, he said, but only after life-saving surgery last month and a harrowing wait that almost killed him.

In Clark's case, the XPS not only kept a pair of donor lungs "alive" for him but also flushed them out so they could be reused. Without the machine, they would have been rejected and thrown away, his doctor said after the surgery.

"I feel great," Clark said last week from his hospital room. "I can't remember the last time I felt this way."

MORE LIVES CAN BE SAVED

In the world of organ transplants, lungs are arguably the most delicate. They are often traumatized in car accidents that kill the donors. They can take on extra fluids or develop pneumonia during a donor's time in intensive care, Lange said.

Most times, surgeons refuse to subject an already weakened patient to a grueling transplant of lungs that are questionable at best. Just one in five pairs is ever deemed usable.

But the XPS is technology that could significantly boost the number of lungs and other organs available for transplant in the coming years and, in turn, save countless lives, said Dr. William Lynch, the transplant surgeon at the University of Michigan Medical Center in Ann Arbor, who operated on Clark.

The University of Michigan and collaborators Henry Ford and Spectrum health systems are considered one of 10 sites around the United States that are part of clinical trials to evaluate the machine, said Mary Pohl, who heads clinical research at Sweden-based XVIVO Perfusion.

A STRUGGLE TO BREATHE

Clark has never been the kind of guy to stay still for long, despite the mucus buildup that gave him a "heavy smoker's cough" even as a young boy.

For years, he lifted weights and traipsed through Michigan's rural acres bow hunting and fishing. He and his family organized events to raise awareness and research funds for the disease. He took classes at Mott Community College and last year was working at a grocery store, despite having to tote around an oxygen tank.

But the disease was taking its toll. By last fall, Clark had developed infections that antibiotics could no longer fight. He struggled to breathe. When he coughed, his chest rattled painfully.

He doesn't remember the trip to a local hospital Oct. 26 or the flight to the University of Michigan the next day.

His mother, Sherry Middaugh, was told that he wouldn't make it much longer.

As it turned out, Clark rebounded for a time, returning home. He'd dwindled to less than 100 pounds — "scary skinny," Middaugh said. An oxygen tank was cranked up to force more oxygen into his lungs.

Despite that, oxygen levels fell once again. He returned to the hospital at the end of January. Oxygen tanks continued to push air into his lungs.

On Feb. 18, just five days after Clark was accepted on a waiting list for a lung transplant, an excited nurse rushed into his hospital room: New lungs had become available.

It was news that was awkward to process, Clark said.

Another family was grieving the loss of a loved one whose lungs he'd receive.

And yet: "Without them, I knew I didn't have much longer. That's the reality of it."

TEST DRIVE FOR LUNGS

As Clark, his mother and his aunt watched movies in the brightly lit pre-op room at University of Michigan's sprawling medical campus, doctors were waiting for the lungs to arrive. The lungs were connected to the XPS in a specialized operating room set aside just for evaluating and maintaining organs.

The XPS, which looks part Zamboni and part robot waiter with a dinner platter, pushes a specialized solution through the pulmonary artery and out the left atrium, giving the illusion the disembodied lungs are breathing on their own, rising and falling in ghostly rhythmic patterns, as they are examined inside and out.

Doctors get an extra four to six hours to feel them, eyeball them, X-ray them, use scopes to check them internally and test them to determine whether they are adequately exchanging oxygen and carbon dioxide.

Finally, it was go-time, staff told Clark and his relatives in the pre-op room.

On his mind as they wheeled him out of the room: This hell is almost over.

Over the next hours, surgeons would slip a scalpel between Clark's ribs, saw through his sternum and open his chest to remove his swollen, scarred lungs.

Clark's mother and aunt were trying to read or sleep in the waiting room, at 12:21 a.m. when the lungs were removed once again from the XPS and placed on ice for a short trip to the operating room.

Hours later, the surgeon told Clark's mom and aunt the surgery had been a success and he provided confirmation that many lungs rejected in the past now simply need time and a "test drive" on the XPS, Lynch said last week.

"What we'll find out is that a lot of these lungs are absolutely fine," he said.

Clark was the 67th patient in the U.S. — the fourth with cystic fibrosis — to receive lungs from the XVIVO Perfusion System.

'REALLY COOL' SCIENCE

Last week, a Batman T-shirt hid the thick, black stitches that run from one side of Clark's rib cage, over his sternum and around to the other side.

Tubes drained extra fluids. Several IV bags provided a continual drip of antibiotics.

But Clark said it's worth it for the result.

The bear tale, he said, is just so he can ease his way into the real story — the much more complicated but important story about "kind of creepy, but really cool" science and the donation of a stranger whose lungs saved his life.

"That's really a better story than anything I'd make up," he said.

What is cystic fibrosis?

Cystic fibrosis is a life-threatening, genetic disease that causes a buildup of thick mucus in the lungs, pancreas and other organs. That mucus buildup can clog the lungs, making it difficult to breath. Additionally, it traps bacteria, which can lead to inflammation and infection and, in turn, severe lung damage and failure.

Those with the disease often have persistent, thick coughing.

In the pancreas, the buildup of mucus blocks digestive enzymes that would help the body break down food. For that reason, those with cystic fibrosis often are malnourished and have poor growth.

About 30,000 people in the U.S. have it. Most today are diagnosed by the time they are 2.

There is no cure for the disease. Life expectancy varies, depending on severity.