Specialists Sam Popa (left) and Erin Larrabee prepare a set of lungs in a Lung Bioengineering operating room. Photo by Lisa Helfert

Heather Phillips was supposed to be getting ready to join her extended family at its annual pumpkin carving celebration in Clarksburg, but instead she was still at work at Lung Bioengineering in downtown Silver Spring. It was late on a Saturday morning in October, and she’d been working all night. Now she stood inside the loading dock of the two-story building awaiting, for the third time in 12 hours, the delivery of an insulated cardboard box filled with ice and a pair of human lungs.

Upon arrival, the driver carried the box inside and helped Phillips place it in a plastic bag on a metal cart, which she wheeled into a nearby elevator. When the doors opened on the second floor, Phillips rolled the cart into one of the six operating rooms at the company’s headquarters.

The operating room was outfitted like other ORs—with bright lights, a ventilator and surgical tools, among other equipment—but the table in the center was far too small to hold a human body, and neither of the two colleagues who’d been waiting for Phillips was a physician. Wearing gray scrubs, surgical masks and gowns, Jesse Kontra and Sam Popa were ready to begin a procedure called ex vivo lung perfusion, which artificially revives the lungs for a few hours. The on-call team—Phillips is an ex vivo lung perfusion technician whose job is to support the team’s specialists, in this case Kontra and Popa—had gotten only a few hours of sleep on bunks downstairs since being summoned at 7 the night before. It was rare to have three cases back-to-back on a weekend, but not unheard of.

The lungs were in limbo, not good enough to be transplanted immediately into a recipient, but not so damaged that they could be ruled out for use. Over the next several hours, the three would work meticulously to slowly bring the lungs back to life, hopeful that the surgical team 21 miles away at Inova Fairfax Hospital would accept them and transplant them later that day into someone whose own lungs were failing.

The team carefully took the lungs from the box. The surgeons who harvested them had placed the lungs on ice immediately for the flight to BWI Airport in Baltimore and the drive to Silver Spring. Now hundreds of miles from the body in which they had spent decades inhaling and exhaling, the lungs sat exposed on a steel table, cold and lifeless.

“That’s when we begin to do our magic,” Phillips says.

Larrabee inspects the blood vessels of donated lungs before ex vivo lung perfusion (EVLP) begins. Photo by Lisa Helfert

Lung Bioengineering sits in the shadow of United Therapeutics Corp., the global biotech parent company whose headquarters occupy two blocks across Spring Street. Inside the smaller building’s operating rooms, the Lung Bioengineering team runs the only facility in the world dedicated solely to ex vivo lung perfusion, according to the company. Also known as EVLP, the procedure allows surgeons, who monitor remotely, more time to evaluate the donated lungs’ appearance and function to determine if they are suitable for transplant.

First performed successfully by a medical team in Sweden in 2005, EVLP was refined by physicians in Toronto, and the “Toronto protocol” is now used by others performing EVLP around the world. The world’s first single lung transplant that resulted in long-term survival took place in Toronto in 1983, after two decades of unsuccessful attempts. Three years later, the Toronto Lung Transplant Program at Toronto General Hospital performed the first successful double-lung transplant.

That program is now led by Dr. Shaf Keshavjee, who helped develop the EVLP procedure and who has transplanted hundreds of lungs after EVLP. In February 2013, Keshavjee met with Martine Rothblatt, the founder of Sirius Satellite Radio who serves as United Therapeutics’ chairman and CEO. Rothblatt, a resident of Silver Spring, created United Therapeutics in 1996 soon after her young daughter was diagnosed with pulmonary hypertension, characterized by increased blood pressure in the lungs. Since then, United Therapeutics has introduced several medications for the condition while also supporting research to address what the company calls the “acute national shortage of transplantable lungs.” Rothblatt invited Keshavjee to her office and asked him what needed to happen to make more lungs available for transplant. Keshavjee says he told her he would increase the use of EVLP by creating specialized centers that would perform the procedure on donated lungs and then send them to hospitals for transplant.