Team Based Care for Lung and Multi Organ Transplant

Podcast Transcript

Kenneth McCurry, MD, and Marie M. Budev, DO, discuss Cleveland Clinic’s leadership in lung and multi-organ transplantation, highlighting innovations like ex vivo lung perfusion (EVLP) and the collaborative care model that supports complex transplant cases. They also spotlight the inaugural Lung Transplant Awareness Day, a national initiative aimed at increasing education about end-stage lung disease.

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute. This podcast will explore disease prevention, testing, medical and surgical treatments, new innovations and more. Enjoy.

Marie M. Budev, DO:

Hello, my name is Marie Budev. I'm the Medical Director of the Lung and Heart-Lung Transplant Program at the Cleveland Clinic.

Kenneth McCurry, MD:

Good day. My name is Kenneth McCurry, and I'm the Surgical Director of the Lung and Heart Lung Transplant program at the Cleveland Clinic. Thank you very much for joining us today. We're here to talk to you about a few pressing issues in the area of lung transplantation, and how we here at the Cleveland Clinic see things and can potentially help you if you are in need.

Marie, I think one of the current issues in the United States, or difficulties, is that there's a lot of patients waiting for combined organ transplants, or what we call multi-organ transplants. So, not only lungs but perhaps lungs plus heart, lungs plus kidney, lungs plus liver. Can you talk to us a little bit about how we approach this at the clinic and how we're able to take care of these patients?

Marie M. Budev, DO:

Yeah, thanks, Ken, for asking. This is a really interesting field, and one that is developing. Multi-organ has been around for a long time, whether we're talking about heart-lungs, liver-lungs-kidneys, but we are making refinements. There's a change in the allocation system that is presently underway regarding multi-organ transplants that's in the works. OPTN (Organ Procurement and Transplantation Network) is working on this, the governing agency.

But there are advances that we are learning about preserving organs, and looking and trying to get donor organs that are multi-organs. There are improvements and advances in this field that the Cleveland Clinic is actually exploring. EVLP (ex vivo lung perfusion) is one way, in special circumstances, to look at these organs separately, whether it's a liver-lung or a heart-lung. But preservation of these organs is also something that we are looking into.

Multi-organ transplant is something that we excel at the Cleveland Clinic in terms of surgical techniques and surgical outcomes, and overall outcomes. So, this is an institution if you are in need of two organs, a combination of lung-heart, lung-liver, lung-kidney, this is where you should come.

Ken, any other additional things you can comment on?

Kenneth McCurry, MD:

Yeah, I would just add what you said just about the expertise of our programs. One of the things I think that really helps us in this regard, in terms of considering patients from multi-organ transplants, is the expertise across the board in all of our transplant programs.

We have a wealth of experience in our lung transplant program, but our liver transplant program is also a very high-volume program, very aggressive in offering patients the opportunity, and our kidney transplant program as well.

When you bring those things together, I think that really puts us in a unique position to be able to offer transplants to candidates who need perhaps a lung and a liver or a lung and a kidney.

Marie M. Budev, DO:

I'd agree that collaboration with our subspecialists and our subspecialty teams, whether it's the liver team, kidney team, is outstanding. We have a very strong relationship, surgical and medical, working with these teams. That can be felt by caregivers and by patients as they go through the process. But again, if you need a multi-organ transplant, please reach out to us for more details regarding this journey and how to get plugged into the system.

Ken, I briefly touched upon EVLP and perfusion in multi-organ, but it's much more common to be used in single-organ lung transplants, and we've been a leader in the country and actually internationally. Could you talk a little bit about our program that you head up here?

Kenneth McCurry, MD:

Yeah, happy to Marie, thank you. As you said, we have a very large volume, very aggressive EVLP program. Just to step back a little bit, EVLP stands for ex vivo lung perfusion, and it's a way of taking lungs that otherwise would not be transplantable for some reason.

Either they're not working well in the donor, there are concerns that are identified at the time of donation, at the time of procurement, and we're concerned about how those lungs might perform if we transplanted them directly.

So we have machines that we can put the lungs on, and we call that EVLP. We can use the machines to evaluate the lungs. We actually have developed strategies here at Cleveland Clinic where we can do things to actually treat the lungs to actually make them better.

As you say, Marie, we've been engaged in this particular area for a long time. We've been very much trying to advance the field and use more organs for patients that are in need of lung transplantation. We see EVLP as a big part of that.

Currently, in the United States, about four out of five lungs go unused, meaning they're not transplantable. So, only one out of five sets of lungs that are offered for transplantation actually ends up getting transplanted, and many of them are not used for the reasons that I just stated.

So, we've been very aggressive at looking at those types of organs, putting them on this EVLP machine, doing things to treat them, to evaluate them and then to make a decision as to whether or not they're suitable for transplant.

Of the lungs that we put on our EVLP machine that otherwise wouldn't be transplanted, we're able to transplant about seven out of ten of those organs, so about 70%. This significantly improves the access to lung transplantation for our patient population.

When we look at the outcomes of those organs that we transplanted after EVLP versus those that we took directly for transplant, the outcomes are equivalent with no difference. We see this as a great tool and a great way of being able to increase the number of lungs that we can make available to our patient population.

Marie M. Budev, DO:

So, the month of October was extremely exciting for lung transplantation. In the month of October, we celebrated the first inaugural Lung Transplant Awareness Day. What was this day about? It was on October 9th, and it was made possible by the Lung Bioengineering and the Lung Transplant Foundations.

This collaboration was a grassroots collaboration that came from actually a patient advocacy group that got together and talked about the fact that more awareness and attention needed to be placed on lung transplantation.

This initiative is a national initiative that will happen every year. It'll bring together caregivers, patients and medical professionals so that we can raise and promote awareness about lung transplantation. So look forward to National Lung Awareness Evaluation 2026, October 9th.

Kenneth McCurry, MD:

As you say, Marie, I know you were involved in this at a very grassroots level. I think this is a really important initiative. There's a lot of misinformation out there about who is and who is not a candidate to get a lung transplant.

I think it's just simply lack of knowledge and perhaps different ways of thinking based on outcomes and candidacy eligibility that were stated 10 or 20 years ago. I think this will go a long way toward helping to educate patients about opportunities that they all have, and hopefully address some of the barriers to access that many patients have had.

Marie M. Budev, DO:

Absolutely. You bring up a good point about access and some of the myths that are out there. It's very important for you, if you're a patient or a caregiver and you're taking care or you have end-stage lung disease, to know where to go to get the right information, the correct information, the most up-to-date information. One of those places is our webpage here at Cleveland Clinic that specifically goes over lung transplant issues, concerns and questions that are frequently asked.

But if your questions and some of your concerns are not addressed on this webpage, there is availability for you to be able to reach out to one of us, either Dr. McCurry or one of our surgeons, or myself and my medical team, so that we can help you and your family along this journey. In fact, we have a patient navigator who will help you through this journey, through your scheduling, through your appointments, where to stay, if you need to have a pet-friendly hotel, where to get oxygen.

We have a lot of resources available, so we can help you through this process. So please, don't be afraid. Reach out, ask us, we're here for you, so we can help you through this journey. This is one that we take with you, and we always keep in touch with your referring doctors so they know where you are in the process. It's a very complicated process, we understand that, but we're here to make it easier for you.

Kenneth McCurry, MD:

We approach things from a team perspective, and we put patients first in our program. So, as Marie articulates, we'll try to help you through this process.

Marie M. Budev, DO:

We're a team of teams, and we do this very well at the Cleveland Clinic. We have a multidisciplinary team that will always be involved with your care. Dr. McCurry alluded to this before when he talked about multi-organ transplant, but even with just lung transplant, there are many teams involved: nutrition, physical therapy, infectious disease, among many of the teams. Everybody is involved with your care, and everybody is accountable for having their own input and helping you along this journey.

Kenneth McCurry, MD:

Marie, I know you just articulated what we would say are a lot of the benefits of getting your lung care at Cleveland Clinic. Do you have any other thoughts for patients as to what the benefits of coming to see us would be?

Marie M. Budev, DO:

That you are central to our care and the reason why we exist. We are here so we can transplant you or help you with your end-stage lung disease and your family. So please, don't hesitate to reach out to us.

Thank you everyone for listening to Love Your Heart.

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