Volume 12
Issue 3
January 2013
SYSTEMnews CEO’s corner Ralph W. Muller
CEO, University of Pennsylvania Health System
The past few years have seen extraordinary additions to the physical make-up of Penn Medicine. The Ruth and Raymond Perelman Center for Advanced Medicine, the Roberts Proton Therapy Center, and the Smilow Center for Translational Research all represent the latest thinking in the design and operation of world-class health buildings. The commitment to excellence that saw these structures advance from concept to construction didn’t end, however, when the last plate of glass was installed and final coat of paint applied. It carries on in the form of several new, system-wide projects that will continue to transform the way we look and how we serve patients. A dynamic feature of the unified Perelman/Roberts/ Smilow complex is its adaptability. Built in stages, the suite of structures holds still more scope for development. So that’s precisely what we’re doing. Construction is underway on the South Pavilion Extension, a five-floor addition that will sit directly over the dock of the Perelman Center. Its 200,000 square feet will comfortably house almost all remaining HUP outpatient services. Freeing up space at HUP will allow us to shift the departments and services now at Penn Tower into the hospital (or other locations) in preparation for razing the Tower and its garage. But while the nearly 40-year old garage may soon be gone, the parking spaces will live on — and then some. Construction of a 1,000-car garage adjacent to Lot 51 is well underway. The new structure will, when the time is right, also support several floors above it, providing added administrative, research, or education space in the future. Moving to PPMC, work is in progress on two major initiatives that will greatly affect how care is delivered in both West Philadelphia and our region in general. The new 11-story Penn Center for Specialty Care will help revitalize the 38th Street area while bringing more health care services directly to the community. The facility, which is scheduled for completion in 2014, will add more than 150,000 square feet of outpatient and surgical care space, including the multidisciplinary Penn Musculoskeletal Institute — as well as offer ample office space for growing technology and science companies. Good Shepherd Penn Partners will also occupy significant space in the building. (continued on page 2)
Inside Making Connections................ 2 Rubenstein to Step Penn Down.................................2 Medicine@Work..............3 From Pastels to PDA’s...............2 Newsmakers..............................4 RoundtableFree Skinfor A Permanent Home Cancer Screening......................3 Those Without...........................5 Shortakes...................................4 Awards and Accolades.............6 Another Title..............................5 New Center for Blood Disorders to Unify SOM Ranked #2.........................6 Patient Care, Research and Public Education....................... 6
`` Edward Cantu, MD, (r) works with procurement surgeon Yoshikazu Suzuki on a donor lung.
Giving Lungs A
Second Chance
`` The excess fluid in the donor lung (top) decreases significantly after two hours of ex vivo lung perfusion (bottom).
Lungs are the most vulnerable of all organs. Indeed, when it comes to viable transplants, the lungs fall far behind other solid organs. This country transplants 10 times more kidneys than lungs, four times as many livers, and 40 to 50 percent more hearts. “Lungs are incredibly delicate. They are the least recoverable and the first organ to go bad,” said Edward Cantu, MD, of Cardiovascular Surgery. “In the U.S., only 15-20 percent of potential donors have viable lungs for transplantation.”
Now, a new technique at Penn repairs damaged donated lungs that would have otherwise been unusable, allowing for the successful transplantation of the reconditioned lung. Called ex vivo lung perfusion (EVLP), the process could potentially double the number of usable lungs for patients awaiting transplantation.
How Does EVLP Work? As a person breathes, air travels down into the lungs, passing through the bronchial tubes and into the alveoli (air sacs). Oxygen goes through a thin membrane into blood vessels as carbon dioxide is removed from the bloodstream. When death occurs, tiny holes develop between the lung and the membrane; water seeps into the lungs from the blood vessels. “All the alveoli that contribute to the breathing process fill with water,” Cantu explained. “The lungs are basically drowning.” As a result of this post-death occurrence, the faster the lungs can be removed from the donor, the less damage they will suffer. Unfortunately, the procurement process — when transplant teams remove organs from a donor — can also adversely affect donor lungs. “My team wants the lungs as dry as possible, to protect them,” he said. “But the other procurement teams want more fluids given to keep their respective organs working well. We have competing interests.” EVLP removes this extra fluid from the lungs, helping to reverse lung injury. During the three- to fourhour process, donor lungs are placed inside a sterile plastic dome attached to a ventilator, pump, and filters. The lungs are maintained at normal body temperature and perfused with a bloodless solution that contains nutrients, proteins, and oxygen. “The solution was developed specifically to protect the lung. It contains recombinant albumin, which acts like a sponge, pulling water out of the organ.” EVLP not only potentially repairs the lung, but also provides an extended period of evaluation to measure the quality of the donor lung. “Getting the lung into this controlled environment allows us to monitor specific parameters,” he said, including how well the lung oxygenates, the peak airway pressure (ie, how much pressure is needed to inflate and ventilate the lung), and lung compliance, which is a measure of how stiff the lung is. “Lungs are like two big balloons. The more elastic they are, the more capable of doing their job,” said Jaya Tiwari, CCRP, who works with Cantu as project manger for the Novel Lung Trial. This multicenter clinical research trial is designed to compare outcomes from lung transplants using the ex vivo technique with those using the traditional method. “If the lung stays stable during EVLP and oxygenates well, we’ll use it,” he said “But if the lung starts to deteriorate during perfusion, we can tell it’s not good for transplant.” (continued on page 5)
1