UK first in Cambridge for double lung transplant patient Daniel

A 49-year-old man has become the first person in the UK to receive a double-lung transplant using a new machine that could improve the number of lungs available for donation.

Daniel Evans-Smith, pictured, received his transplant at Royal Papworth Hospital NHS Foundation Trust in Cambridge, where a surgical team used a technique called ex-vivo lung perfusion (EVLP).

“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,” he said.

“I was woken early in the morning to news that a potentially suitable set of lungs had been found and they were going to be put on the machine to assess them.

“It was very sudden but the lungs performed well and the transplant went ahead.”

The technique is widely used in Europe and the United States but has not yet become common practice in the UK.

It involves taking donated lungs which are initially considered to be marginal for use in transplantation and reconditioning them outside the body in a special machine – the XPS system from XVIVO.

This improves their quality to make them suitable for donation.

Although there have been a handful of EVLP transplants in the UK before, these have largely been limited to clinical trials or have used different machines.

This new machine, and the establishment of a dedicated EVLP programme at Royal Papworth Hospital, is a significant breakthrough in improving lung transplantation in the UK.

Royal Papworth is the only UK centre using EVLP for clinical cases and four patients have now benefitted from this technique.

As a former cigarette smoker who quit 12 years ago, Daniel had developed chronic obstructive pulmonary disease (COPD), a lung condition that causes breathing difficulties and can worsen over time, limiting normal activities and requiring oxygen.

He suffered a collapsed lung on five occasions between late 2023 and early 2024 and was initially treated at Northampton General Hospital.

He was then transferred to Royal Papworth Hospital for further assessment and to manage his condition.

Placed on the lung transplant list earlier this summer, Daniel was still in the hospital and ready to be discharged home when he was awoken by nurses to the news that suitable donor lungs had been identified.

Daniel said: “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.

“I can already walk further than before, climb hills without thinking about it and I don’t have to rest so often.”

With ex-vivo lung perfusion, the explanted lungs are placed in ice as normal, but then when they arrive at the recipient’s hospital they are attached to a machine that will perfuse and ventilate the donor organs.

This machine mimics the environment of the human body, allowing the lungs to inflate and deflate as normal.

A special fluid maintains the lungs and helps to restore the normal function and allows the donor lungs to be maintained and possibly improved.

The lungs can be maintained in this way for up to four hours. This allows a dedicated team of highly trained specialists to complete a detailed assessment and administer short-term therapeutics if required.

If the lungs perform well over at least three hours of testing, they are removed from the system and put on ice for delivery for transplantation.

Daniel’s transplant operation was carried out by a multidisciplinary surgical team led by consultant surgeons Marius Berman, Giuseppe Aresu and Pradeep Kaul.

After rehabilitation first in critical care and then on the surgical ward, he recently returned home to Northampton to continue his recovery.

“The team at Royal Papworth are very supportive. Even outside of my appointment times, they want to know if I’ve had any kind of colds or infections so they can react as quickly as possible to prevent them becoming problems for my new lungs,” Daniel said.

Mr Berman, surgical lead for transplantation at Royal Papworth, said without this innovation, Daniel may still have been waiting for a transplant today.

“While this marks another important milestone for our lung transplant patients, it also marks a new beginning for Daniel who continues to receive expert care from our multidisciplinary teams,” he said.

Jas Parmar, transplant consultant at Royal Papworth and also chair of the Cardiothoracic Advisory Group (Lungs), added: “We are delighted to be able to offer this opportunity to these very ill patients in need of lung transplantation.

“We have only been able to do this with the support that we have enjoyed from our trust, NHS England, NHS Blood and Transplant and of course all donor families without whom this work would be impossible. We are always indebted to their selfless act of organ donation.”