Saving organs. Saving lives. Building the world’s first organ regeneration lab

By John Gregory and Jonathan Kearns

We had one chance to get it right,” says Christopher Rizzo, Executive Director of Redevelopment, University Health Network, “Building two mini-operating rooms in a live suite of twenty sterile ORs. We’re talking about a city of individuals that are having different surgeries in sixteen to eighteen ORs at any one time.”

“The first day we did our site review was the day that COVID hit,” says Keith Button, Senior Architectural Designer at Kearns Mancini Architects (KMAI), “We were on site when everything locked down. We had to get the Director of Infection Control at UHN to help us exit the hospital.”

Not the typical start to a new project, but then again this is the most unique project on the planet. Rizzo and Button are speaking about the design and building of the world’s first Organ Regeneration Laboratory (ORL) at Toronto General Hospital (TGH), the number one transplant hospital in North America.

The TGH transplant surgeons who developed the regeneration technologies had been honing their techniques in an existing operating room. ORs can be up to 700 to 1,200 square feet so it was overkill for their spatial needs and not the best use of precious hospital resources. They brought the concept of a dedicated lab to Rizzo.

In the past, if organs were in any sort of trauma, if they weren’t perfect, they couldn’t be transplanted. The organ regeneration lab is using technology that was perfected at Toronto General; it’s called perfusion. Perfusion effectively keeps the organ alive for an extended period in a specialized environment like an incubator, which gives the team time to work on the organs and get them ready for transplant.

“Covid shut down elective surgeries,” says Button, “the ORL project freed up one of the ORs that they were using for a jerry-rigged version of the regeneration lab. Time was tight. We had to do the work as fast as we could so that the additional OR could be used to deal with the surgical backlog created by COVID.”

“These are the projects you do once in your life.” Rizzo says. “Two designated mini-ORs that have created the ability to regenerate or repair organs for transplant. There’s a third area which is called the islet room that harvests stem cells from a pancreas, and is being used to treat diabetes, reversing the effect of the disease in some patients.”

Toronto General completes 12001400 transplants a year, with a success rate hovering around 98 per cent.

“We’re in pretty esteemed company on a global scale,” says Rizzo, “we were the first to transplant a lung and the first to transplant double lungs. Right now, if a recipient needs double lungs, they are getting them in one operation. Our track record is probably the best you can get for surviving major transplants.”

Ground-breaking work is being done in these facilities, but breaking ground to build them was just as challenging.

“It was like playing Tetris in a fully functioning operating ward,” says Button, “we couldn’t do one thing without it affecting something else. We had to free up three rooms that were already in use. One for perfusionists, another for anaesthetists and an equipment storage room. Just to free up these three rooms we had to renovate 12 locations in the hospital – most of them in the operating suite itself.”

Due to the tight schedule and a need for experienced team players, the design-build team of Dineen Construction and Kearns Mancini Architects was selected to deliver the project.

“From start to finish,” commented Rizzo, “we did the project in less than 12 months, so it was a monumental task.”

The greatest concern for the surgeons was headroom. A lot of equipment on articulated arms is hung from the ceiling in a typical OR. There needed to be enough clearance so that the equipment did not clash, however ORs normally have a 10-to-12-foot ceiling height. The rooms being renovated for the regeneration lab did not have more than 8 feet of headroom. The design/build team from Dineen/ KMAI had to work with manufacturers of the lighting and equipment booms to have the least possible depth of the equipment overhead.

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