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Giving the Breath of Life: New Collaboration Between Sheba and Toronto General

The two hospitals join forces to advance lung transplantation in Israel, revolutionizing how the procedure is performed and putting Sheba on the global map of lung transplantation.

A new collaboration between Sheba Medical Center and Toronto General Hospital aims to advance lung transplantation in Israel, as well as develop medical education in both Israel and Canada. Last year, the Institute of Pulmonary Medicine at Sheba founded a new lung transplant program. This initiative is headed jointly by Dr. Liran Levy, who spent four years in clinical, research and surgical training at Toronto General, and Dr. Milton Saute, who pioneered lung transplantation in Israel.

Sheba’s partnership with Toronto General “will put Sheba on the map of lung transplantation,” said Dr. Amir Onn, Head of Pulmonary Medicine at Sheba, primarily due to progressive technology that can increase the number of donor lungs significantly – by almost 50 percent.

The world’s first successful lung transplant was performed at Toronto General in 1983. Since then, the hospital has expanded its program. In 2013, Dr. Marcelo Cypel, a staff thoracic surgeon at Toronto General and director of their ECLS (extracorporeal life support) program, made a breakthrough discovery with the development of an innovative technique called ex vivo lung perfusion (EVLP), which doubles the amount of time donor lungs can be stored outside the body. As Cypel said in a recent webinar moderated by Canadian Friends of Sheba, this technique “effected a change in paradigm for how we perform lung transplants.”

“Previously, donor lungs could be kept for only six to eight hours,” said Cypel. “Patients had to uproot their lives to live near a transplant center, and staff had to race against the clock to transfer the organ from the donor to the recipient, often forced to perform the complex surgery in the middle of the night.”

The logistics of the transplantation are thereby simplified, and the valuable extra hours also give the organ more time for recovery. Cypel explains that generally, more than 80% of donor lungs are unsuitable for transplantation because of infection, blood clots, poor function or injury. But by pumping a solution of nutrients, proteins and oxygen into the injured donor lungs, the EVLP system promotes healing of the injured cells, or it prepares them better for advanced repair techniques. In the last seven years, this system subsequently doubled the number of lung transplants performed in Toronto.

Dr. Saute expects that with the aid of Toronto General, the EVLP program will become operational at Sheba by the middle of 2021. As he stated in the webinar, “We anticipate that [EVLP] will make a huge impact and significantly increase the pool of donors for lung transplantation in Israel, especially now, during COVID, with the number of donors reduced by more than 50 percent.”

Collaboration with Toronto General will also include clinical consultations regarding complex cases and an exchange of trainees between both hospitals.

We hope to send members of our team to Sheba to learn from their unique expertise,” Cypel said.

Regarding the recent reduction in donor lungs, Cypel believes it can be blamed partly on the number of deaths that occur at home because patients are reluctant to be hospitalized during the pandemic. Additionally, lockdowns have resulted in fewer car accidents from which victims supply donor lungs.

Another effect of COVID, as Dr. Onn pointed out, is that the virus has created new potential candidates for lung transplant. Currently, he is treating patients at Sheba’s specialized post-COVID clinic who present with symptoms such as shortness of breath, chest pain and memory problems. Some of these patients have sustained irreparable damage to their lungs.

An increasing number of people who have recovered from COVID are being referred to the lung transplant center. “We are in the process of identifying those who may be potential transplant candidates,” said Dr. Levy.

The partnership with Toronto General is particularly meaningful for Levy, who spent years in Toronto with his family, and found it hard to leave his former colleagues and mentors behind.

“The Jewish community made us feel very much at home, and we still miss Toronto,” he said. “But I think we have a very important mission here in Israel.”

Levy isn’t the only physician with emotional ties to Toronto General. When teams from both hospitals met last year to discuss the partnership, Saute and Cypel discovered they were both born in the same city in southern Brazil, and Saute knew Cypel’s grandparents quite well. Additionally, they shared the same mentor in thoracic surgery.

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