"A deceased donor kidney has been preserved and kept healthy outside the body in a device that mimics the bodys physiological functions and successfully transplanted into a human for the first time in North America. The technique unique solution and device are part of a Phase I clinical trial at Toronto General Hospital TG University Health Network UHN assessing the safety of the device with subsequent phases examining its efficacy. Kidneys are the most frequently transplanted solid organ but a continuing shortage of donor kidneys impacts wait times and quality of life of those waiting for a transplant. One way to address this gap by the transplant community worldwide has been to extend the criteria of those donor kidneys used for transplantation. But these extended criteria organs  those from older donors or from donors who have two or more risk factors  do not tolerate current cold storage methods for organ preservation well. This can result in greater injury to the kidney or in a sleepy kidney which functions poorly at the beginning requiring dialysis until it recovers days or weeks later. This early delayed function also impacts its longerterm survival. In Ontario about  per cent of all transplanted kidneys are expanded criteria donor kidneys. This means donors are on average older than  years or younger than  years and likely have hypertension higher BMI body mass index diabetes or died due to stroke. Ex vivo organ perfusion is an innovative organ preservation technique that seeks to overcome the limitations of current cold storage method of preservation. Developed in the laboratory of UHN transplant surgeon Dr. Markus Selzner with the help of UHN transplant surgeons Drs. David Grant and Anand Ghanekar as well as Drs. Lisa Robinson and Darius Bagli from The Hospital for Sick Children SickKids it took four years to perfect the solution for the donor kidney and to modify the heartlung machine for use in the warm perfusion technique.   This technology has advantages over the usual cold storage method in which a deceased donor kidney is cooled on ice to about four degrees Celsius with no oxygen slowing down its metabolism and inhibiting the repair process. The kidney cannot survive longer than  hours in cold preservation. The new warm preservation technique avoids the damage of cold storage and instead allows the donor organ to improve and repair itself potentially leading to better outcomes for patients. Using a heartlung bypass machine with customized tubing adapted to the kidneys smaller blood vessels  and a specially blended preservation solution of blood nutrients minerals amino acids oxygen glucose antibiotics and drugs  surgeons nurses and perfusionists at TG prepared a deceased donor kidney in a transplant operating room to be placed in a warm preservation solution before transplantation into a patient in late November . The aim was to enhance kidney function minimize injury and avoid a sleepy kidney from an extended criteria kidney. About  per cent of deceased donor kidneys do not work immediately requiring longer hospitals stays for the patients and dialysis. Zhao Xiao  received the deceased donor kidney which was placed on the device for . hours at body temperature. I feel great says Xiao through an interpreter. He was able to get up and walk two day after his transplant. Xiao says he was happy to volunteer to become the first patient to receive a kidney that was improved by the new technology. This can make a difference to other patients so I am glad to be the first one helping them with my experience. As soon as the donor kidney was reattached to the patient it turned rubyred and started to pour out urine indicating that it was functioning well. It is a champion says an elated Dr. Selzner who has done about  kidney transplants in the past  years. It behaved like a normal kidney despite it being an extended criteria donor kidney. He points out blood tests within  hours showed that the kidney was removing wastes and excess fluid from the blood normally. Since the kidney did not struggle after transplant there is a greater likelihood that its longterm outcome will be better he adds. This technique will change the landscape of organ donation by improving organ preservation allowing us to better assess and regenerate the donor organ on the device before we transplant it into a patient. We will know how healthy that organ is before the transplant operation says Dr. Markus Selzner coinvestigator of the clinical trial. Dr. Selzner a clinicianscientist at the Toronto General Hospital Research Institute and Associate Professor of Surgery at the University of Toronto previously modified the preservation solution and supervised the research on a successful warm perfusion technique for the deceased donor liver organ. Working on this project has been one of the most rewarding experiences of my professional career says Dr. Lisa Robinson Division Head of Nephrology at SickKids. It is exciting to see this work be transformed from an idea to experimental research and now to directly impacting patients. Even with the shortage of donor organs we have to decline some of our donor organs because of the damage they sustain in the retrieval process says Dr. David Grant Surgical Director of the MultiOrgan Transplant Program UHN. He is also coinvestigator of the clinical trial and transplanted the donor kidney which was on the modified heartlung bypass machine into the recipient. This new technology can help us answer the critical question Whats the best way to improve function and recover and repair the kidney before transplantation to get the best results for our patients      Dr. Grant who is also Professor of Surgery at the University of Toronto emphasized that highimpact research projects such as this require strong collaborative teams  including researchers surgical residents nurses Canadian Blood Services perfusionists colleagues at SickKids  working together on experimental and clinical trials. UHN is one of the few places in the world where you can have a good idea and then find the right people to make something like this happen. Other collaborators on the research and clinical trial at UHN include Drs. Joseph Kim and Anand Ghanekar coleads of the kidney transplant program at UHN and transplant nephrologist Dr. Istvan Mucsi. Dr. Grant also praised the strong support and efforts of Trillium Gift of Life which coordinates organ and tissue donation across Ontario in helping to ensure that the transplant team could begin their clinical trials with this new technique. The technique of warm organ perfusion outside the body was pioneered by the Toronto Lung Transplant Program at TG in  by Drs. Shaf Keshavjee and Marcelo Cypel to better treat repair and assess highrisk donor lungs outside the body. The lungs are placed in a protective dome in which a system continuously pumps a bloodless solution of oxygen proteins and nutrients into the injured donor lungs mimicking normal physiological conditions. This makes it possible for the injured cells to begin repairing themselves and sets the stage for more sophisticated repair techniques to be applied to donor lungs. Since  there has been an unprecedented  per cent increase in lung transplants at TG as a result of this system. At any point in time there are about  patients waiting for a transplant in Ontario. About  people wait for a kidney transplant across the province usually about four years. About five per cent of people on kidney waiting lists die every year. Research for the ex vivo kidney perfusion project was supported by the Canadian National Transplant Research Program CNTRP a national research network designed to increase organ and tissue donation in Canada and enhance the survival and quality of life of Canadians who receive transplants.  Generous philanthropic support made through Toronto General  Western Hospital Foundation has played and continues to play an integral role in the development of ex vivo technology and its impact on patients lives.   About Toronto General Hospital Toronto General Hospital is a partner in University Health Network along with Toronto Western the Princess Margaret Cancer Centre Toronto Rehabilitation Institute and the Michener Institute of Education. The scope of research and complexity of cases at Toronto General Hospital have made it a national and international source for discovery education and patient care. It has one of the largest hospitalbased research programs in Canada with major research in transplantation surgical innovation cardiology infectious diseases genomic medicine and liver disease. Toronto General Hospital is a research and teaching hospital affiliated with the University of Toronto.  http To download video and photos of the ex vivo kidney perfusion circuit and kidney transplant please visit BROLL       Preparing ex vivo kidney circuit in the OR httpsdrive.google.comfiledQebXsGT_jrVgeBFIZijZrWqKAhQview    Kidney transplant surgery httpsdrive.google.comfiledBCZuyALMmeMeUkZvyYRvbJZccEview  Dr. Markus Selzner      Clip   httpsdrive.google.comfiledYlnRecrnGCfhRoHxHUGdJ_Fhview  Clip     httpsdrive.google.comfileduCovJHAOMUtKRpxZVtzzmIfunYZOview  Photos httpsdrive.google.comopenidIUK_aXngLEac_AOTfUHqlUWrd         Photo credit Courtesy of University Health Network"