Northwestern Medicine Performs the Highest Number of Lung Transplants in the United States

In an effort to expand the donor pool for lung transplant recipients and give surgeons more time to removed diseased lungs, the Northwestern Medicine Canning Thoracic Institute (CTI) is now routinely repairing damaged donor lungs using “lungs in a box” (lung perfusion) technology and storing them for transplantation by putting “lungs in a fridge” (lung refrigeration). These innovative approaches are yielding dramatic benefits for patients and staff alike.

In 2024, CTI’s Lung Transplant Program finished the year by performing 148 lung transplants, their highest volume for a single year since the program began 10 years ago. For the first time, CTI also become the highest volume lung transplant center in the United States and achieved the shortest wait time for a lung transplant, with a median wait time of four days.

“Since our lung transplant program launched 10 years ago, several innovations helped us reach these achievements for 2024. From performing the first COVID-19 lung transplants in the US, to starting a lung transplant program for select patients with advanced lung cancers, and replacing diseased lungs with breast implants to bridge patients to lung transplantation, we’re continuously thinking outside the box and ‘lungs in a fridge’ is another example,” said Ankit Bharat, MD, chief of thoracic surgery and director of the Canning Thoracic Institute. “In 2024, we used ‘lungs in a box’ to repair the most number of donor lungs that weren’t initially usable at Northwestern Medicine, enabling us to achieve a record wait list time of only four days. And now, with controlled lung refrigeration, we can keep the lungs alive outside the human body for an extended period of time, giving us more time to prepare for transplantation and perform the surgery.”

“With a combination of ‘lungs in a box’ and ‘lungs in a fridge’ technologies, we also now have the option for patients at any transplant center in the country or overseas who experience longer wait times to dual list with us, and in 2024, patients traveled from places such as Germany, the United Kingdom and Columbia to receive a lung transplant at Northwestern Medicine,” said Ambalavanan Arunachalam, MD, pulmonologist and interim medical director of CTI’s Lung Transplant Program.

Lung refrigeration was pioneered in Canada and Europe, and within the last few months, it was adopted successfully at Northwestern Medicine, where organ procurement specialists travel to hospitals across the United States to collect donor lungs, and once the lungs arrive at Northwestern Memorial Hospital, staff place them in a special refrigerator which is set at 10 degrees Celsius. The lungs can remain in the fridge up to 12 hours before transplantation when the conventional techniques only allowed them to stay outside for about six hours.

“Prior to using the fridge, we were storing the donor lungs on ice, which is four degrees Celsius, and we had to perform the recipient lung implant surgery immediately without the opportunity to extend the preservation time,” said Anitha Chandrasekhar, DMSc, clinical lead for lung bioengineering with the Canning Thoracic Institute. “Studies show that 10-degree Celsius storage of lungs allows safe prolongation of cold ischemic times, results in better mitochondrial health with reduced inflammatory response, ultimately leading to better post-transplant outcomes, benefitting patients and health care teams.”

Four Main Benefits for Using “Lungs in a Fridge”

Widens the Donor Pool

Lung refrigeration widens the donor pool by allowing Northwestern Medicine’s organ procurement team to travel greater distances for donor lungs. Previously, there was only so much time that the lungs could be kept alive outside the body, which restricted how far the organ procurement specialists could travel. From the moment they’d take the lungs out of the donor, they’d have six hours to package up the lungs, get to a local airport, fly to Chicago, drive to Northwestern Memorial, take the old lungs out and put the new lungs in.

“With this new type of preservation, our organ procurement specialists can fly to the East Coast, West Coast and potentially even Canada or Mexico. As a result, our wait times for lung transplant patients have dramatically gone down,” said Dr Arunachalam.

Fewer Overnight Transplants

Storing donor lungs at 10 degrees Celsius allows for more flexible transplant scheduling. Lung refrigeration helps improve transplant logistics, which in turn, makes lung transplantation a semi-elective procedure performed during normal working hours.

“Previously, these transplants would happen in the middle of the night when the team may not be in the best physical or mental capacity. For example, if the procurement team arrives at 1 am with the donor lungs, we can now put the lungs in the fridge and wait to do the transplant at 7 am. By keeping the lungs preserved at 10 degrees Celsius, the team can operate during regular hours after a full night’s rest, which helps with success rates and lowers the chance of medical errors,” said Dr Bharat. “Also, given the tough hours for lung transplant surgery, fewer surgeons have been interested in the field, resulting in a significant shortage of thoracic surgeons. But with this new strategy, more talented surgeons may be interested in adopting lung transplantation in their career.”

Improves Surgical Schedules

Transplants are often unpredictable. Donor lungs can become available on short notice, so in some instances, elective surgeries have to be cancelled in order to get the transplant done in time, which causes an inconvenience for patients who have been waiting for their elective surgeries (ex: cancer patients). “Lungs in a fridge” allows the surgical team to keep elective surgeries and schedule the lung transplant procedures during times that work best for staff and patients. It also helps lung transplant recipients because they no longer have to rush from their home to the hospital in a short period of time to get their lung transplants within the six-hour window.

“Lung refrigeration provides us with more options for getting our transplant recipients one step closer to a better quality of life,” said Denisha Gardner, organ procurement specialist with the Canning Thoracic Institute. “There are times when our recipients need a certain medication to be given hours before transplantation. Having the fridge allows us the opportunity to make sure everything is aligned for a successful procedure.”

More Time to Remove Diseased Lungs

Double-lung transplants are one of the most complex medical procedures in health care. Lung refrigeration gives surgeons more time to remove the diseased lungs, especially in patients with lung cancer.

Northwestern Medicine started a first-of-its-kind clinical program called DREAM that provides double-lung transplants to select patients with advanced lung cancers who are out of treatment options. With these patients, their cancer-ridden lungs must delicately be taken out at the same time along with the lymph nodes, then surgeons need to wash the airways and the chest cavity to clear the cancer before transplanting new lungs. These patients can have billions of cancer cells in the lungs, so surgeons must be extremely meticulous to not let a single cell spill into the patient’s chest cavity or bloodstream.

Having more time in the operating room to remove the cancer-ridden lungs can help reduce the risk of recurrence.

Successful Patient Outcomes With Lung Refrigeration

Tadd Crosslin – Mansfield, Texas

Tadd Crosslin of Mansfield, Texas, (located in the Dallas-Fort Worth metropolitan area) received a double-lung transplant at Northwestern Memorial on September 23, 2024. The 49-year-old who is married (wife is Courtney) with twin sons (Cody and Blake), was diagnosed with stage 3 colorectal cancer in 2016 at the age of 40, and it advanced to stage 4 by 2019.

While undergoing chemotherapy and surgery, Crosslin’s medical team noticed lung nodules forming but told him not to worry. Soon, the lung nodules started multiplying and Crosslin had hundreds of tumors on his lungs, which caused him to have difficulty breathing.

“I traveled to major health systems in Texas, California, Florida, New Jersey, New York and even Germany, looking for a second opinion, but they all told me there was nothing more they could do,” said Crosslin. “Giving up was never an option for me, and Northwestern Medicine doesn’t shy away from exploring new techniques and technology. Without them, I wouldn’t be here today.”

On September 23, Crosslin received his new lungs, but the surgery wasn’t easy. Because there were so many tumors and extensive cancer inside Crosslin’s old lungs, his explant was extremely difficult (see pictures here).

“Having the refrigerator was a game-changer in Tadd’s lung transplant procedure,” added Dr Bharat. “Because his diseased lungs were fused so tightly to his chest cavity, we kept needing more time to remove them. We couldn’t let his new lungs go bad, so we were able to store them in the fridge until we were ready to transplant them.”

The Double Lung Replacement and Multidisciplinary Care (DREAM) Program is a first-of-its-kind clinical initiative at Northwestern Medicine that provides double-lung transplants to select patients with advanced lung cancers who are not responding to conventional treatments. To date, more than 40 patients have received double-lung transplants through the DREAM Program.

Amanda Long – Nashville, Tennessee

Amanda Long of Nashville, Tenn., is also a DREAM patient. The 48-year-old wife (husband is James) and mother of three daughters (Kenzie, Maddie and Makenna) was diagnosed with stage 4 lung cancer in September 2023.

“As a non-smoker who eats healthy and works out five days a week, I was completely shocked by the diagnosis,” said Long.

When immunotherapy and chemotherapy treatments didn’t work, Long’s medical team in Nashville recommended she reach out to the lung transplant team at Northwestern Medicine. Long was listed for a lung transplant on August 15, 2024, and received her new lungs on August 21.

Because it took the surgical team longer to remove her diseased lungs due to the cancer, lung refrigeration was also used to store Long’s new lungs. Long is now back home in Nashville and will return to Northwestern Memorial once a month for follow-up appointments.

“The fridge is so simple and doesn’t further complicate what might be one of the more complex procedures in health care. If anything, it makes everything go more smoothly for the team in the operating room,” added Jeff Lysne, practice administrator for the Canning Thoracic Institute. “Overall, it’s been great to see such a simple innovation used to expand our donor pool and help more patients.”

For More Information

In 2024, the lung transplant team used “lungs in a fridge” for approximately 12 patients, all with good outcomes. Since CTI’s Lung Transplant Program started in 2014, they’ve performed nearly 600 lung transplant procedures. Currently, more than 900 patients in the US are waiting for new lungs.

Patients interested in being evaluated for a lung transplant can contact the referral line at 844.639.5864. For more information about Northwestern Medicine, as well as advanced therapies, visit nm.org.