UF Health’s lung transplant program was the first in Florida when it started in 1994. While the transplant center was the state’s leading program until about 2008, other Florida hospitals began doing transplants, especially beginning in the early 2000s. (Today, five hospitals perform transplants in Florida.)
With more hospitals competing for donor lungs, it became more difficult for the UF Health program to maintain its numbers. Lungs that had once gone exclusively to UF Health were now being distributed among several hospitals.
By 2014, UF Health performed just 12 lung transplants.
But Machuca, who arrived at UF Health four years ago, and other team members helped spearhead a more aggressive approach to lung transplantation.
“The main characteristic that drives us is that we believe in innovation,” Machuca said. “And we constantly are challenging the status quo.”
One of the program’s key pivot points came in 2015 with the establishment of UF Health’s adult extracorporeal life support program.
The team uses a device widely known by its abbreviated name, ECMO, short for extracorporeal membrane oxygenation. ECMO oxygenates a patient’s blood while removing carbon dioxide, functioning as an artificial lung. ECMO is essential to keep patients alive while awaiting a transplant in case their lung capacity further deteriorates. It also is used during surgery.
Before ECMO, if newly transplanted lungs did not begin adequately functioning in the hours after surgery, often the only way to save a patient’s life was for them to undergo another grueling transplantation with a new set of donor lungs. And that assumed new lungs could be found before the patient died.
“We’ve learned that we don’t need to re-transplant these patients anymore,” Machuca said.
The Extracorporeal Life Support Organization last year awarded UF Health its Gold Level ELSO Award for Excellence in Life Support for its exceptional care using ECMO in adult and pediatric cases.
UF Health also takes a more aggressive approach in selecting donor lungs. About 75 percent of donor lungs nationally are initially deemed unsuitable for transplant because of problems such as impaired gas exchange or pulmonary edema. But those problems often can be reversed by using the XVIVO Lung Perfusion System, a technology that allows the lungs to be kept alive and improved so that they can become eligible for transplant.
In addition, UF Health is one of just a handful of hospitals in the nation where surgeons can resize donor lungs through lobar transplantation. Traditionally, women and men of smaller stature and pediatric patients have waited longer for lungs that will fit their chest properly since donor lungs are often from taller men who have suffered a traumatic injury.
“If you wait for the perfect match to come, the trade-off is that your patient might die,” said Andres Pelaez, M.D., the medical director of the lung transplant program and an associate professor of medicine in the UF College of Medicine. “By offering lobar transplantation, our program can overcome this significant barrier and avoid deaths on the wait list.”