UK's First 'Lungs in a Box' Double Lung Transplant: A Game-Changer for Organ Donation

The UK’s First Double Lung Transplant Using “Lungs In A Box” Marks A Groundbreaking Milestone in Organ Transplantation

The medical world has recently witnessed a monumental advancement in the field of organ transplantation, with the successful completion of the UK’s first double-lung transplant using the revolutionary “lungs in a box” technology. This breakthrough procedure, which utilizes a machine known as the XPSTM system by XVIVO, is poised to change the landscape of lung transplants, offering new hope to patients who are on the waiting list for a life-saving transplant.

The transplant was performed at the Royal Papworth Hospital NHS Foundation Trust in Cambridge, UK, a leading institution known for its expertise in lung transplantation. The patient, 49-year-old Daniel Evans-Smith, had been battling chronic obstructive pulmonary disease (COPD), a progressive lung condition that left him with severely compromised respiratory function. His life was hanging by a thread, and without a lung transplant, his doctors had warned him that he would not survive much longer.

A New Hope for Lung Transplantation in the UK

The advent of Ex-Vivo Lung Perfusion (EVLP) has been hailed as one of the most significant advancements in lung transplant technology in recent years. The EVLP system, also known as the “lungs in a box”, is capable of reconditioning lungs that may otherwise be deemed unsuitable for transplantation due to factors like age, previous infections, or minor damage. This technology enables doctors to assess the functionality of lungs outside the body and improve their viability, providing more transplant opportunities for patients who desperately need them.

Historically, the shortage of suitable donor lungs has been a major obstacle for those on the transplant list. Many lungs are discarded because they are considered marginal or unsuitable due to factors like prolonged ischemia (lack of oxygen) or slight injury. However, with the introduction of EVLP, marginal organs can now be evaluated and potentially reconditioned for transplant. This innovation has the potential to reduce organ waste and increase the number of life-saving transplants performed each year.

What Is Ex-Vivo Lung Perfusion (EVLP)?

EVLP is a groundbreaking technique that is becoming increasingly popular in the United States and Europe, although it has been slow to gain traction in the UK. The procedure involves taking donated lungs that may be considered less than ideal for transplant and placing them in a machine that mimics the human body's natural functions. The lungs are perfused with a special solution that helps restore their function, and they are ventilated in a way that simulates natural breathing. This technique allows doctors to evaluate whether the lungs can be safely transplanted into a recipient.

Once removed from the donor, the lungs are placed in a cooling solution to preserve them temporarily. At the recipient’s hospital, the lungs are connected to the EVLP system, which maintains the organ’s functionality outside the body. The system uses a special fluid to provide nutrients and oxygen to the lungs, and it ensures that they are properly ventilated by inflating and deflating in a manner that mimics natural breathing. The machine allows for a period of controlled evaluation lasting up to four hours, during which the doctors can assess the lungs’ viability and make any necessary adjustments. If the lungs perform well for a specified period, they can be safely cooled and then used for transplantation.

This process is a significant breakthrough because it opens the possibility of using organs that would previously have been discarded, increasing the available supply of donor lungs. For patients like Daniel Evans-Smith, who have no time to wait for a perfect match, EVLP offers a crucial chance to receive a transplant that could save their lives.

The First Successful Case: Daniel Evans-Smith’s Journey

Daniel Evans-Smith’s life was at a breaking point when he was added to the lung transplant list in the summer of 2024. Diagnosed with severe COPD, Evans-Smith had endured several lung collapses, with the condition rapidly progressing despite treatments. He was living with constant fatigue, shortness of breath, and an inability to carry out even simple daily tasks. By the time he was hospitalized for the final time in late 2024, it was clear that without a transplant, his survival was unlikely.

Fortunately, Evans-Smith received life-saving news in early 2025: doctors had identified a pair of suitable donor lungs that could be reconditioned using the EVLP technology. The transplant procedure took place successfully at Royal Papworth Hospital with the help of the XPSTM machine, and within hours of the surgery, Evans-Smith was breathing with renewed strength.

“I feel very privileged to have been offered the opportunity to be in this situation,” Evans-Smith remarked after the surgery. “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.”

After the transplant, Evans-Smith experienced a rapid improvement in his quality of life. “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,” he continued. “I can already walk further than before, climb hills without thinking about it, and I don't have to rest as often.”

His recovery, along with the success of the transplant, serves as a testament to the potential of EVLP technology. For Evans-Smith, this technology offered not just a second chance at life, but a future free from the debilitating symptoms of COPD that had once seemed insurmountable.

The Impact on Lung Transplantation in the UK

Lung transplantation has always been a difficult procedure, complicated by the limited number of suitable donor lungs available. In the UK, many patients are forced to wait for extended periods for a viable match, and in some cases, those who desperately need a transplant pass away while waiting. The introduction of EVLP technology promises to reduce these wait times and increase the number of successful transplants performed.

Dr. Jas Parmar, a Transplant Consultant at Royal Papworth Hospital, emphasized the significance of this breakthrough: “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.”

Royal Papworth Hospital is currently the only medical center in the UK using EVLP for clinical lung transplants, although other institutions have been involved in clinical trials or have used similar machines in the past. This breakthrough represents a major step forward in the field, and it’s expected that other hospitals will adopt this technology in the coming years.

The Future of EVLP in Lung Transplantation

With successful cases like Daniel Evans-Smith’s, EVLP technology is poised to become a standard in lung transplant programs across the world. The ability to recondition marginal lungs for transplantation could dramatically reduce organ wastage and improve patient outcomes. However, despite its success, there is still much research to be done. Medical professionals are working to refine the technique further, and ongoing studies will assess the long-term effectiveness and outcomes of using reconditioned organs.

As technology continues to evolve, it’s possible that EVLP could be used to treat other organ types, or that even more advanced methods of organ preservation and reconditioning will be developed. The ultimate goal is to address the critical shortage of donor organs and provide more people with the life-saving transplants they need.

Conclusion: A New Era for Lung Transplants

The successful double-lung transplant using “lungs in a box” marks a new era in the field of organ transplantation. Thanks to the XPSTM system and EVLP technology, patients who once had no hope of receiving a suitable lung transplant now have a renewed chance at life. The future of organ donation is bright, and technologies like these are paving the way for better outcomes, higher success rates, and ultimately, saving more lives.