Lung Transplant Donation & Matching

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Tomorrow’s Cure: Inside EVLP.

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Mayo Clinic experts explain how ex vivo lung perfusion, or EVLP, allows transplant teams to evaluate some donor lungs outside the body before deciding whether they are suitable for transplant.

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Lungs are a little bit

different than some of the other organs in

this country. 13% of donors recover and

donate lungs, far lower than liver, kidney,

or heart transplant. If we can improve those

numbers, get quality lungs, not only will

the outcomes continue to get better for

those patients listed, but we will be able

to then continually list more

patients and offer lung transplant

to more patients. Every year, thousands

of patients wait for a life-saving lung

transplant. but the need for donor lungs is

greater than the supply. Traditionally, donor

lungs are either accepted or rejected. There's

no middle ground. Until now. Ex vivo lung

perfusion, or EVLP, is a groundbreaking

procedure that evaluates lungs

outside the body. EVLP can transform what

was an unusable lung into a potential

lifesaver. That's the topic we'll dive into

during this episode of Tomorrow's Cure, a

podcast from Mayo Clinic that brings the future

of medicine to the present. I'm Kathy Worser.

It's great to have you with us. Joining me

right now to talk about new ways to increase

the supply of usable lungs and what this

means for patients are Dr. Jack Haney. He's a

cardiothoracic surgeon at Mayo Clinic in

Florida. And Brandy Zofke is here, Associate

Vice President at Lung Bioengineering. Dr.

Haney and Brandy, thank you so much for joining

us. I appreciate your time. My pleasure.

Thanks so much for having me. Dr. Haney, I want

to begin with you because I think most

of our listeners have very little idea of what

happens when it comes to being on a wait list

for a lung transplant, just the anxiety

and stress that that can cause for a patient

and their family. Would you mind telling us

what the wait is really like? Well, I think

it's an important point because it's something

that we sometimes underestimate, quite

frankly, and it's one of the reasons,

honestly, I do what I do. Breathing is the

most basic brainstem reflex, right? And

we've all been short of breath. When you're

a kid, you're being tickled until you can't

breathe or where you're swimming and dove

too deep and are fighting to get the

surface. We've all kind of experienced that.

Or maybe it's we have asthma or we've had

a respiratory virus. And we've also all

seen friends and family be short of breath.

It can be an incredibly terrifying

thing to be short of breath. And again,

it's one of the most fundamental basic

instincts that defines your brainstem being

alive is the drive to breathe. And so when

patients are on a wait list for lung

transplant, it by definition means they have

end stage lung disease. These are

patients who are on oxygen, on oxygen all the

time, right? At rest, brushing their teeth,

taking a shower. People who get incredibly

short of breath doing basic, you know,

minimal tasks of daily living and who are

incredibly anxious and incredibly stressed by

that feeling. There's basically no exit,

right? All you can do is try to stop the coughing

fit, try to calm down and turn up the

oxygen, right? But there's a very powerless

feeling when it comes to being short of breath.

And that powerless feeling extends to their

loved ones. Most of us have probably

experienced having a loved one, friend and family,

short of breath, and it is an incredibly

helpless feeling, right? And so one of the

reasons, quite frankly, I like doing lung

transplant is not just for the patient, but for

the caregiver, because we see a tremendous

amount of caregiver stress and quite

frankly, PTSD from loved ones who haven't slept

soundly in a year because they're basically

living with someone that they can't fix,

that they can't help. And they're waiting for

the moment in which that breathing gets

bad enough that there's nothing they can do. And

so that is an incredibly emotional and powerful

at a very base level fear. So being

on a lung transplant waiting list is an

incredibly stressful, scary thing. How long does

it normally take if one's on a list from

the time they're on the list until the time

they may get a new lung? So it depends. Lungs

are allocated not by time on a list, but by

severity of illness. And we've made some

adjustments in the last couple of years to how

that process works. It depends on a lot of

variables. the sicker patients get the

highest priority because they have the biggest

risk of dying waiting. So it depends on your

lung disease, depends on your score, something

called the CAS score. It depends on your

blood type. And so we still have inequities

in this country depending on blood type.

But we've made a lot of improvements with the

current listing process and the way the

computer does the math. And so the median waiting

time today appears to be about a month

and a half. That can vary widely. The sickest

patients, patients who are in the hospital

on machines, sometimes their waiting time is

a matter of days to a week. On the other

hand, more stable patients sitting at home on

oxygen may wait months. Even those patients,

it becomes a glass half full or glass half

empty, right? They're not as sick, they're

stable, they're not going to die, but

they're slowly drowning over time. And that can

also be a very anxiety -provoking and frustrating

process. Brandy, I know you've been with

Lung Bioengineering for what, about a

dozen years or so. Why is this work so important

to you personally? When lung bioengineering

was created by United Therapeutics, it was

founded to find a cure for pulmonary

arterial hypertension patients. So historically,

United Therapeutics has focused on these

medicines to help this patient population after

our founder's daughter was diagnosed at a

very young age. She developed United

Therapeutics, and the next phase of her efforts was

around increasing and influencing more

patients getting a lung transplant because

eventually this patient population will need

a lung transplant. And that is where she

decided to start lung bioengineering, optimizing

ways to re-evaluate lungs that currently

aren't being used today. I'm wondering, Dr.

Haney, let me ask you a little bit about

the supply and demand situation. There

is a mismatch right now for lung

transplantation in this country. So lungs are

a little bit different than some of the

other organs, kidney, heart, liver. There's

not nearly the huge discrepancy in

terms of people listed for transplant and

organs available. Currently, there

are about 3,300 lung transplants done per

year in this country, and each year about

3,600 people get added to the list. So

there is a relative balance compared to

something like kidney, for example, or heart

transplant, where truly there are lots

of people for whom an organ is

inaccessible. Now, that doesn't mean there's

not a discrepancy and a disparity between

supply and demand. One of the reasons

that number could be higher is if there were

more lungs available. And right now, lungs

remain the hardest organ to place from a

donor. Part of that is physiologic. Lungs are

very sensitive. They're this tissue paper thin

membrane that's very sensitive to factors

and can be disrupted by infection, by fluid

overload, by lots of things, right? But the

bottom line is lungs have probably the lowest

recovery rate from available donors in 13

% to 15% from a donor in this country. 13%

of donors recover and donate lungs, and

that is far lower than liver, kidney, or heart

transplant. So the discrepancy really

exists in that if we can improve those numbers,

get quality lungs, Not only will the outcomes

continue to get better for those patients

listed, but we will be able to then continually

list more patients and offer lung transit

to more patients. Quality lungs. Brandy, what does

that mean to you? Lungs are

really difficult because there's so

much subjectivity involved in

the evaluation. When your brain

sends out a signal that it's time to

die as a result of this injury that

the organ donor has sustained, the lungs

being that very delicate tissue can

really be impacted. And even the process of

being on a ventilator can allow for

additional infections in those types of patient

population. So when the transplant team

is trying to evaluate whether or not this lung

might work for their recipient, they've got

a lot of challenges ahead of them. Like Dr.

Haney mentioned, fluid imbalance and other

multi-system organ issues can be masking

the way that the lung actually could perform

if you would take it outside of that environment.

When a transplant physician is trying

to evaluate all of these factors, that is

where lung bioengineering can help with our ex

vivo lung perfusion technology to be able

to take a lung out of the organ donor,

put it on a device, gather data without all

of those confounding factors, and give the

transplant physician the information that they

need to make a better decision on whether or

not that lung should be used for their

particular recipient. What happens exactly

when you get an organ and it goes on the

machine, right? What kind of tests do you

have to run? How do you talk to the

transplant team and then deliver the organ? So

typically the way the process starts is that

the transplant center has received an offer

for their patient from the organ

procurement organization. And they have questions

that or they've got a couple of red

flags. And so they are going to have

that organ recovered and sent to one of

our two facilities. And when the organ

arrives, our clinical team of our clinical

specialists are on site and ready to receive

that organ. And it is cannulated on the back

table. So they take two cannulas and sew them

into the vessels. So one is going into the

left atrial cuff and the other one into the

pulmonary artery. And then they're going to

put an endotracheal tube into the airway and

flush that organ. And then they put it on

the device and they're going to connect those

cannulas into the tubing for the perfusion

to start. So now the lung is cold and it's

got cold solution that's going to be flowing

through it. and every 10 minutes the temperature

is increased and the flow rate is increased

and until the lung warms up to a certain

temperature then it starts to ventilate

and every hour after it goes on evlp we're

gathering data from the ventilator and from the

blood gases so we're i say blood gases

but it's actually an acellular perfusate. So

we're actually drawing solution out of the

lung and evaluating how well the lung is performing

and putting oxygen into the solution,

just like it would in your body. And then we

do bronchoscopies of the lungs. So we take a

little tiny camera and put it down into the

airways and look around and evaluate and make

sure everything is dry and intact. And we

also are capturing x -ray images of the

lungs throughout the procedure. We have live

feeds into our operating suite, so our specialists

are able to communicate directly with the

transplant physician. But they're also able

to see everything through that same system

as if they were there, everything short of

physically touching the lungs themselves.

That becomes a historical repository for the

transplant team as well, with pictures and videos

that we're capturing that will aid in

their decision making and maybe a tool for

them downstream if they ever have any issues

and need to look back at that organ. Every

hour, the team is checking in and looking at the

data and communicating with the team. We

have ex vivo lung perfusion consultants

available to dial in and assist in any decision

making or evaluation that may be of concern

from that particular organ. And then at a

certain point in time, the transplant team

decides that they have or have not received

enough data. And if they're happy, they

tell us to cool down. So we kind of do the

reverse where now that warm lung is going

to be rapidly cooled down and taken off

of the circuit and packaged up to be

transported back to the transplant hospital.

Can you then, with EVLP, recondition the lung,

in a sense, if there has been, say, injury

to it? Can it be healed before it's

used in a patient? What we are doing today

is actually just re -evaluating a lung.

One of my colleagues coined a phrase, turning

a no into a maybe, and taking these

lungs that maybe you wouldn't take direct

to transplant, putting them on the device,

and then using that data to reevaluate

whether or not you should use that organ. What

does this device look like? You have

to describe it to me. It is made up of several

components that you would see in a traditional

hospital setting. One of those is a

ventilator, so the lungs are actually breathing,

for lack of better words, on the system.

And then they're attached to a circuit

that is actually perfusing solution through the

organ. So we're able to see how the lung

acts as the actual oxygenator of that solution.

So it's a combination of a lot of different

components that make up these different

types of EVLP devices. Dr. Haney, you've

seen this. What do you think? It's basically a

lung that's ventilating in a plastic dome that

you can see moving and ventilating, and

it's pretty neat. So it's like the heart-lung

machine, but without blood, and it takes

that organ out of the confounding factors

and isolates it to say, hey, is this organ

working the way we expect it to work? To

your question about rehabilitating organs,

I think to a degree that happens. We treat that

organ with antibiotics. We can sometimes get

fluid out of the lung, etc. And certainly the

promise of the machine is as a platform for

doing more things to that organ over

time. To date, though, I would say at this point

in late 2025, it is still primarily viewed

as a longitudinal information source,

right? How does this lung work over a period of,

you know, two to four hours? Does it work

as I would expect? And does it work in a

way that I think is compatible with what I

need for my patient? And if that lung is not

doing what you want it to do, then Brandy,

what happens after that? So the transplant team

can decline the organ, and they may be

declining because it's not the right lung

for their particular recipient. So for example,

perhaps one of the lungs is potentially

usable, but his, Dr. Haney's recipient, needs

a double lung. In those situations, we work with

the organ procurement organizations to

identify other potential recipients. If the

lung is not usable, then that lung

would go back to the organ procurement

organization for direction on

being discarded. Getting back to you

personally here, Dr. Haney, as the surgeon,

if indeed you run across a lung that you have

to say no to, what's that like to tell a

patient that this isn't going to work at this

point? I think it's all about the expectations.

We are interested in looking at organs,

right? Taking risks on going to look,

right? As Michael Jordan said, you miss 100%

of the shots you don't take. I always have

loved that shots taken, quote, doctor. But as

a hockey fan, because I am from Minnesota.

I think that was Wayne Gretzky who first

made that wonderful quote, who first said

that. And that may be true. And I do love

the great one. But as a born and bred North

Carolinian, I think it certainly sums up Michael

Jordan's attitude. Point taken. So if we declined even

to go to look at an organ, we're obviously

not going to use that. We have the lowest

fidelity of information about an organ, a

lung donor, than we do any other solid organs

basically, right? We have an x-ray that's

kind of hazy. We have a mechanical ventilator

that works exactly the opposite way in

which you naturally breathe. And we have a

blood gas. And so it's very difficult to assess

an organ from afar before the time of

donation. In addition, 50% of organ donors

in this country today, for a lot of reasons,

are donations after circulatory death or

DCD. For those donors, there is not a beating

heart period where we are able to assess the

lung, inflate it fully, feel it, look at it,

test it at the time of donation. And so

there is a tremendous amount of uncertainty

about that organ. That's where EVLP really

provides, in my opinion, a huge advantage

because we can take that organ out, put it on

the machine and test it for a few hours and make

a decision as opposed to having to make a

decision with very limited data beforehand.

When I'm talking to a patient, first of

all, I want to set the expectation that when

we are going to look at an organ that nothing

is guaranteed, right? Don't count your chickens

before they hatch. We're going to look at

these organs because if we don't look, we

know we're not going to get them. But with

the expectation that sometimes those organs

are not good. And then I also tell the

patient, look, if this is not a good organ,

you don't want it. The last thing we want to

do is set you up for an early, very rocky

course. And that's where some of it depends on

the patient. How much do I need this specific

organ? Is it the exact right size? And

this is a very difficult size match. Are there

lots of antibody issues? And this is the

one immunologic match, right? How much can

this patient tolerate some early struggles

coming out of the case? Is this a young, robust

patient that could tolerate a lung that I

think is fundamentally good, but might struggle

for a little bit? Or is this someone who

I really need an organ to work well right

away because they're a little more frail, they

need to have something that's really good.

And by the way, are they stable and can

wait, right? So those are all parts of the

equation going in. And that's why sometimes a

program may turn down an organ for a specific

patient that still may be usable and may

be reallocated to a different patient at a

different site. And EVLP really helps facilitate

figuring all that out and assessing the

organ independently. So it sounds as if

this is really changing how the number and type

of lungs can be used in your particular

program at Mayo. Yeah, it really has. So in

the last several years, we've really leveraged

EVLP to do exactly what you just described

to increase the number of organs

available. And a lot of that, again, comes down

to confidence in the organ and finding the

right organ for the right person. Where

do we want to take our risks? If we're not

comfortable putting the patient at risk of

having a rough start and being set up for

complications, EVLP allows us to be reassured

that this is going to be a good organ. So

over the last several years, close to, you

know, 40 to 50% of our transplants have gone

through EVLP. There's a number more organs

that we've sent for EVLP that we've declined,

right? That we've said, you know what,

for various reasons, they're not good. I

think it's also changed even how you and your

team look at organs, right? I think you're

actually probably as a result of working

with us, we've seen organs that in the

early days may have come in for EVLP,

but now you're taking direct to transplant

because your team is going and actually

looking at more organs. So it's actually

a kind of a cultural change as a result

that we've noticed in working with your

program. And we see that transcend across

a lot of programs. This is, in a

lot of ways, just as much art as

it is science. Interpreting data, figuring out what

organs are usable, what are good, what are

not good, what's going to happen with a DCD

donor, all of these things you learn. And

my use of EVLP has changed over time. And

it also has a lot to do with where you're

willing to at different programs or with

different patients where you're willing to

take risk. And I think EVLP fundamentally

allows you to take less risk, to bear less

risk as a program and as a physician for a

patient because you have more reassurances

that an organ is going to perform well.

And so it really has dramatically improved

our ability to not only use more organs,

but also, I think, find the right organ

for the right patient. The one-year mark in

a transplant is key. It's incredibly important.

And I'm wondering, what are you seeing

in terms of the early outcomes and the

one-year results for patients who receive

lungs through EVLP? This is a technology

that, as we said, has been around for over

a decade. It also has evolved. The early

studies showing EVLP was safe basically were

non-inferiority studies to say, hey, listen,

we think a lung from EVLP has the same

level of short, intermediate, and longer

-term outcomes as a lung that didn't come from

EVLP. What continues to happen as we test

these is we move the goalposts, right? We

send different organs. We gain more confidence

with it. We send sometimes, quite frankly,

lungs that we were less sure about. I think

we have a reasonable amount of data and

certainly anecdotal experience and my

personal experience having done a ton of

transplants that an organ coming off EVLP has

the same short and intermediate term outcomes

as a lung that was not on EVLP. There's

not really a price to be had in the short to

intermediate term for that organ. Now,

long-term, obviously, that takes years and

years to determine, but we don't have any

evidence that says that there's any long-term

implication. And we think that if a patient's

early and intermediate results, meaning

days, weeks, months, year, predicts their

long-term success, what I tell patients is a

lung from EVLP that works is going to be

just as good and you're going to have just as

good a chance of doing well long-term as a

lung that doesn't come from it. And if it

means getting you an organ, like we went back

to the beginning, the reducing the waiting

time, getting you out of harm's way, out of

that high oxygen demand where you're worried

if tomorrow's going to be your last day,

right? If we get you transmitted safely and

set you up for success, there's no difference

long term between a lung that spent a few

hours on a machine and one that came directly

from a donor. The other thing about

lung transplant, quite frankly, is that the

difficulty of lung transplant long-term beyond

EVLP is still the immunosuppression, the

medicines. Lung transplant is a tough business

and the median survival for lung transplant

is about six years, which is about half

the survival of heart transplant or liver

transplant. I like to describe it to patients

as the best of some bad options. And lung

transplant can be fantastic. And I have patients

texting me and families texting me all the

time. Patients out living their lives,

doing things that they could never do. And EVLP

is a part of that. I have a lot of patients

transplanted who got lungs because of EVLP

that they might not have gotten. There are

a tremendous number of success stories that

we certainly in the business have to hold

on to because it doesn't always work well. But

EVLP certainly has been a huge part of

our ability to expand and offer lung transplants

safely. The future is great and the future

is really bright. EVLP is a part of that

future. It's a platform for organs to be out

of a body between donor and recipient for

several hours. People have tried a variety of

different therapeutic interventions on those

organs, and to date we haven't hit on

the one, right? And whether it's going to be

a gene therapy, whether it's going to be a

drug therapy that makes the organ work better,

makes it more tolerable to the immune system,

etc., someone is going to hit upon

something that makes a dramatic difference in

the organ performance. In my opinion, it's

most likely immunologic, right? Because that's

the biggest long -term problem is that

these are not your lungs and they didn't come

from a box on the shelf, right? They're

from another person. And so when we have an

ability to make that organ look more like

you or look less threatening to your body,

that's when we're going to have a big benefit.

And there are a number of strategies

with lung transplants, some of which United

therapeutics is very heavily involved in,

right? Whether it's xenotransplant and

modifying pig organs to use in people, or whether

it's rescaffolding pig lungs with human

cells to basically grow a human lung in the

lab or 3D print a human lung, right? United

Therapeutics has companies and subsidiaries

doing all of that work. But certainly

EVLP as a technology offers a lot of promise

to say, hey, we can make better lungs to

put into more patients. Brandy, I'm interested

in the potential use of this for a

genetic modification. If you can revitalize

a lung on a cellular level with

this, with oxygen and nutrients and

that kind of thing, healing cells, I wonder,

can those same cells possibly be genetically

modified so they would function like the

patients own? I think it is very futuristic.

I think this is something that we

believe that ex vivo lung perfusion will be used

for is to be able to be used as a platform

for potential therapies like that. Right

now, when organs are recovered, they're

transported in a cold manner and it goes from

donor to recipient and there's not a lot of

time and being able to administer those types

of therapies. And those are going to take some

time to be able to deliver. I do think

that that is the promise of what we're doing

today is that hopefully someday someone out

there will have a way to be able to do

just that and be able to give patients on the

downstream a much better organ than what we

can give them today. I'm a realist. I like

to think about what we're doing right now,

but I also think that future is around the

corner. And I think that United Therapeutics

has put a lot of different irons in

the fire, not knowing what the future of that

is going to look like. I'm not sure. I couldn't

tell you exactly what I think the

future therapy is going to be that makes the

biggest difference for those lungs. I certainly

have guesses, but there's nothing so

close around the corner that I could tell

you, oh, this is going to be in clinical

trial next year. That said, I think not only

is EVLP, you know, a useful technology right

now, I really think it has tremendous

promise as a tool, as a, as I said, as a

platform for those interventions. And I think

we are inevitably going to see significant

progress, probably from an immune standpoint

to make that better. You know, I was

wondering, as we've been talking here, equity,

of course, is a big focus in medicine. And

might this platform, Brandy, be used to

maybe make more organs available across the

board and really do help when it comes to the

questions of equity in organ transplantation?

Yeah, I think that's the thing we're most

proud of, is that every organ that currently

comes in for EVLP is an organ that wouldn't

otherwise have been used. So being able to

put more organs into the system will allow

for more patients to be able to receive these

lifesaving transplants and getting back

to, you know, Dr. Haney's comment earlier

about patients with end stage lung disease

and eventually being able to potentially

expand those indications. I think that's what's

going to be really helpful. And that's

something that we've done today with having

transplanted over 600 patients just out

of our facilities. Might this also help

the smaller, less resourced centers that can

also benefit from this? Yeah. Historically,

these devices, and still today, some

transplant hospitals have these devices within

their transplant hospital. But with that

requires a very large resource with staffing,

the capital investment, managing all of

the consumables and very specialized

products that go with this that have very

short lifespans. And the way that

lung bioengineering does it is

that we kind of have centralized

those resources. And so we actually

serve right now 25 lung transplant programs

in the United States out of our two facilities.

So the organs can come from anywhere.

We've brought lungs in from Alaska and from

Puerto Rico. And it goes out to one of those

transplant programs that are qualified

to use this medical device. And that means

that the smaller programs that would never have

been able to invest in all of this

equipment and expertise now can leverage a

service provider to be able to do that. And so

we do think that this is bringing more

options to more patients through being able

to serve the large transplant programs as

well as the small ones. Doctors, since you

have been working with EVLP, how will you think

EVLP protocols will become routine rather

than experimental in some places?

Making it more routine ultimately involves being

comfortable with the procedure and not

perceiving it as high risk. And so that's why,

you know, that thousand EVLP case experience

has really been instrumental. The

published data showing that these organs have

similar outcomes, it really helps tremendously

to alleviate that perception of this

being an experimental or only for big programs

that can bear risk process. Quite the

opposite. In fact, I view EVLP as the way for

especially smaller programs to mitigate

risk. I completely agree with Brandy's comments.

EVLP, especially centralized EVLP,

allows organs to be accessible to lots more

programs, again, programs that don't have the

resources to provide these services on

their own, but also are smaller and may not

have the denominator and the capacity to

bear risk from things like DCD donors where

there's uncertainty. EVLP allows you to

be more reassured that this organ is

going to perform well. If it's a smaller

program that, again, wants to be

conservative, I no longer think of EVLP lungs

as an aggressive, forward-thinking, sort

of experimental thing for big, aggressive

programs. I think of it as a fairly conservative

thing. And in fact, the riskier move is

to say, I know better, we don't need to use

EVLP in these donors. And to your point

about equity, I mean, listen, equity is a

really critical thing. I mentioned before there

are discrepancies in waiting times, blood type

discrepancies, right? Even though O blood

group is 50% of the population, people with

blood type O, whether it's lungs or heart,

because they can only take O, are at a

disadvantage for getting organs. There's no question.

And we've continued to try to adjust the

modeling to try to reduce that discrepancy,

but that discrepancy exists. Anything we

can do to improve the number of available

quality organs is going to improve equity. There's

no question. And so I think EVLP certainly

as a platform provides for more organs

available to more places, to more programs, and

thus to more patients in need. So if you

were to both look out five to 10 years from

now, where do you think this lands? What are

you most excited about when it comes to this

particular platform? I'm most excited for

the future of utilizing therapies on ex

vivo lung perfusion. There's a broad spectrum

of organs when it comes to evaluation.

There's the perfect ones that are going

direct to transplant, and there's the ones

that aren't even considered for ex vivo

lung perfusion today because of those issues

like infection or trauma, for example. So

if we could shift the spectrum to being able

to expand into even more indications,

we'll only help be able to serve more patients

that are waiting. I'm most excited about

seeing what therapeutic interventions we can

perform using the EVLP platform. Again,

whether it's a gene therapy, whether it's a

drug delivery, something that makes the organs

fundamentally perform better is going to

be very exciting. And there's been a lot

of changes, right? Improvements in cold static

storage, understanding how tolerant lungs are

of time and ischemia. So previously we had

to put organs in. We thought between six

and eight hours. Now we have organs out of

the body, whether it's EVLP or not, for 24

hours. The entire landscape of transplant

has changed in which, as she mentioned, taking

organs from Alaska, from Puerto Rico, all

across the country, the timing of it, et cetera,

has really changed. And I continue to

look forward to seeing EVLP platforms be a big

part of that landscape in which many more

organs for which we have a lot of uncertainty

are put on EVLP as our expertise and the

quality of EVLP continues to rise. And then

those organs can be allocated and sent all

over the country to the appropriate waiting

recipient to best match the organ with

the recipient. I think it's an exciting time

to watch that continue to unfold. I started our

conversation by asking you about how you talk

with your patients. And so it sounds as

though the conversations you are having with

your patients right now, doctor, and into

the future are going to be different, are

different because of this platform. There's

a lot of different factors that go into

assessing a donor organ. We talk about the fact

that there's a lot of tools utilized and that

EVLP is one of those tools. It has also

changed the way in which we view time and we

view a donor run. And oftentimes then it has

taken a huge bit of the time pressure off

of us, not just EVLP, but our ability to

kind of leave lungs in a cooler safely, et

cetera. So now the conversation is, it's not

a fire drill. This isn't delivering a baby

and have the suitcase ready by the door kind

of thing. There's a conversation where the

patients are at home. We're going to go look

at an organ. It's a DCD. We're probably

going to use EVLP. The patient stays at home

until we better assess, right? So there's a

conversation and a time pressure that's been

alleviated by this. And it's an ongoing

process of, we're going to look at this organ.

We'll let you know. But all of it involves

using multiple tools, again, including EVLP to

say, we're fundamentally trying to make the

best decision we can for you, the patient,

to try to find you an organ that's going

to work well for you. Really interesting

conversation, both of you. Thank you for your

time, Dr. Jack Haney from Mayo Clinic in

Florida, and Brandy Zofke, Associate Vice

President at Lung Bioengineering. We

appreciate you. Thank you. Thanks so much, Kathy. Thanks for having me. Tomorrow's Cure is

a production of Mayo Clinic with production

help from the Podglomerate. Be sure

to follow Tomorrow's Cure wherever you

get your podcasts. I'm Kathy Wurzer. Thank you so much

for listening.