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Organ perfusion - lung

Methods for preserving and evaluating donated organs

Static cold storage
Standard method for preserving donated organs

Static cold storage

For the last 50 years, the established preservation method for lungs has been based on static cold storage. The aim of cooling is to reduce metabolism, thereby decreasing the need for oxygen and nutrients. Durability is limited with this method, however, and the preservation period varies depending on the organ. Also, the method does not enable assesment of the organs’ suitability for transplantation.

For preserving and evaluating donated organs

Machine perfusion

Machine perfusion constitutes the delivery of a perfusate through the organ’s vasculature. It can be used for storing organ sduring transport, as an alternative to static cold storage. The method can be applied after static cold storage to assess organs for their suitability for transplantation.

Static Cold Storage

Products for static cold storage of donated lungs

XVIVO’s main product for static cold storage is the proprietary preservation solution PERFADEX Plus. The product has been the standard treatment in lung transplants for more than 25 years and is used by more than 90 percent of transplant clinics globally. PERFADEX Plus is approved on all major markets. Static cold storage entails cooling the lungs by flushing the major blood vessels with a cold solution (PERFADEX Plus). Cooling slows metabolism and thus preserves organ function. In addition to lowering the temperature, PERFADEX Plus also flushes out donor blood that contains substances that can damage the lungs. Lungs are subsequently stored in PERFADEX Plus in bags on ice, but also temperature controlled containers can be used during transport to the recipient hospital and are held this way until transplantation.

Machine perfusion

Products for warm perfusion of donated lungs

Static cold storage is an established and safe method. One limitation, however, is that it is not possible to assess donated lungs in a cooled state. Since lung transplantation is a life-changing but complicated procedure for the patient, surgeons refrain from using donated lungs of uncertain quality. This means that up to 80 percent of donated lungs are rejected for use in transplantation.

Normothermic Ex Vivo Lung Perfusion (EVLP) is a method used to assess donated lungs ahead of transplantation. It entails connecting the lungs to a machine and perfusing them with STEEN Solution upon arrival at the transplant clinic. The lungs are warmed to body temperature with a pump, providing circulation and a ventilator simulating breathing. The normothermic EVLP method recreates an environment similar to that inside the body (in vivo), which gives the lungs and their cells the opportunity to recover. While the lungs are outside the body, transplantation teams can assess their function using various parameters that can be read from the machine.

XVIVO offers products for EVLP

  • XVIVO Perfusion System (XPS), an integrated machine with all components required for normothermic EVLP.
  • Products for manual EVLP in which clinics put together their own system, using equipment available in the hospital.

XVIVO Perfusion System (XPS™)


A comprehensive EVLP platform that offers an overview of the entire process.

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Products for manual EVLP

STEEN Solution™ 

A buffered extracellular solution intended for the assessment of isolated lungs after removal from the donor in preparat...

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XVIVO Organ Chamber™ 

A sterile single-use container intended to be used as a temporary receptacle for isolated donor lungs in preparation for...

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XVIVO Lung Cannula Set™ 

A sterile single-use set that connects isolated donor lungs to an extracorporeal perfusion system for ex-vivo assessment...

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Static Cold Storage (SCS)

During SCS the lungs are flushed with a protective preservation solution (PERFADEX Plus). The lungs are then placed on ice in a bag containing the same solution. By lowering the temperature of the lung, cellular metabolism and oxygen demand is reduced.


Ex-vivo lung perfusion (EVLP)

EVLP is a process that enables the lung to function outside the human body. The lung is attached to a ventilator, pump and filters that mimics the functionality and environment of the body. This enables assessment of the lung and extends preservation time before a potential transplant.

Possibilities with EVLP:

  • EVLP can be performed on marginal or initially unacceptable lungs and thereby increase the number of transplantable lungs
  • Extended assessment and preservation time offers logistical advantages​

Lung Perfusion

Normothermic Ex Vivo Lung Perfusion


The first human EVLP transplant was performed in Sweden by Professor Stig Steen and his colleagues in 2000. This ground-breaking procedure also marked the first successful lung transplantation from a DCD (Donation after Circulatory Death) donor. Since its introduction, EVLP has become a powerful tool in lung transplantation to increase the number of transplantable lungs and to decrease mortality on the transplant waiting list.

Increasing the number of transplantable lungs

Normothermic EVLP provides clinicians and transplant teams with a setting for donor lung assessment and allows for extended preservation/logistics and treatment of lungs that otherwise might previously have been considered unacceptable for transplant.

EVLP – allows assessment of initially unacceptable lungs

EVLP allows assessment of initially unacceptable lungs.

Making it possible to recover organs initially unsuitable for transplant.

Patient outcomes comparable with standard lungs.

Post-transplant outcomes are comparable to standard lungs

Outcomes with marginal lungs transplanted after EVLP are comparable to those of standard donor lungs.

EVLP – extends the preservation time

A combination of static cold storage and EVLP can extend preservation time*.

Offering logistical advantages through extended preservation time.

Extending time for patient selection and preparation, and to choose the optimal treatment strategy.

Gives the opportunity of scheduling daytime surgery, which offers flexibility with staff and better access to resources.

*Extended preservation time: Cold Ischemic Time 1 (CIT 1)+ EVLP time + Cold Ischemic Time 2 (CIT 2)

At the forefront of EVLP

EVLP 30%

Implementing an EVLP program led to a 30% increase in transplant activity.

EVLP 30%

In experienced high-volume centers, 30% of lung transplants have gone through EVLP assessment.

EVLP 70%

EVLP conversion rate 70–95%.

How to establish a successful EVLP program – step 1-2

In this first video our Global Product Manager Carianne Nilsson gives you an introduction highlighting some initial considerations on how to establish a successful EVLP program.

How to establish a successful EVLP program – step 3-6

In this second video our Global Projects and Clinical Specialist Manager Marx Runge gives you additional keys on how to establish a successful EVLP program.

How to establish a successful EVLP program – step 7-8

In our last video our Global Product Manager Carianne Nilsson will indulge you with the final steps in the 8-step process on how to establish a successful EVLP program.

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