Austin Hospital Performs Landmark Double Transplant with Perfusion Tech

Frank Giamarelos was still alive when the waiting kidney and liver arrived at Austin Hospital at midnight for the first double transplant in Australia.

The liver, which was no longer inside the human body and sat in a plastic box, was fed sugars and nutrients it would normally receive from the digestive tract via normothermic machine perfusion.

The dark reddish-brown organ was also pumped with warm, oxygenated blood through plastic tubes, allowing the liver to make its own bile and cleanse it of any toxins.

Nearby, another machine hummed, keeping the donor kidney in active hibernation; its cells are still breathing and processing oxygen as if it had never left a body.

Associate Professor John Whitlam, medical director of Austin Health’s kidney transplant service, said perfusion technology was transforming every aspect of organ transplants in Australia and globally.

This included the way surgeons work, the types of patients who can donate organs, and even the recipients’ outcomes.

“The idea that there’s basically an organ outside the body and it’s kept alive by a machine is pretty science fiction,” Whitlam said. “So cool, so weird.”

Most importantly, organ perfusion allows doctors and transplant surgeons at Austin Hospital to test the viability of donated organs before they are transplanted. The technology works in a way that can replicate conditions inside the human body.

“So cool, so weird.”

Associate Professor John Whitlam, medical director of Austin Health’s kidney transplant service

For the first time in Australia, a team at Melbourne’s Austin Hospital has used pioneering perfusion technology to perform a double transplant on 51-year-old father of two Frank Giamarelos, who was on the verge of organ failure.

Giamarelos had been diagnosed with a rare genetic disorder known as hereditary polycystic liver and kidney disease. He was living in debilitating pain; His stomach had bulged out, his liver had weighed over nine kilos, and his kidney had reached 1.2 kilos.

He had trouble breathing, had severe back pain, and some days was so exhausted he could barely move.

Giamarelos’ kidney function was running at six percent. He had been on the organ waiting list for almost two years, until he received a late-night phone call in October last year and was told a kidney and liver from a donor were finally ready.

Before this call, Giamarelos had agreed to be part of the landmark study at Austin Hospital; This meant he could be the first recipient in the country to receive perfusion of both organs prior to transplantation.

Giamarelos, who works in the field of medical diagnostics, did not hesitate to participate in the research.

“I was aware of the risks, but I was willing to take them,” he said. “These experiments, if you want to call them that, are very important for modern medicine, and they could help many people in the future.”

When Giamarelos underwent the grueling and complex 16-hour surgery, his kidney and liver were enlarged and filled with fluid-filled cysts, Austin Health transplant surgeon Graham Starkey said.

“The cysts were like little water balloons,” he said. “It looked like something alien, like the surface of the Moon.”

Starkey said perfusion allows organs to be stored safely for hours longer, extending the window of time during which they can be transplanted.

“The point is, this is to eliminate the barriers for someone like Frank to receive a transplant,” he said.

“This means we can do complex cases that take longer without compromising the patient’s outcome.”

Whitlam said normothermic machine perfusion (which keeps the organ at 37 degrees at human body temperature) is used for the liver, while hypothermic machine perfusion is used for the kidney.

“This is a simpler technology because it uses a cold liquid, like salt water, and oxygen is added to that liquid, it goes through the organ and keeps it in hibernation,” he said.

“The advantage of this is that it doesn’t degrade at the same rate as it does at room temperature.”

This meant the kidneys could be stored safely for up to 30 hours. He has previously said that the process of preserving the organs is “essentially keeping them in a cardboard box with ice.”

“We call it static cold storage, and it’s actually kind of like an esky,” he said.

Austin Health is the first hospital in the nation to have both liver and kidney perfusion machines, which include normothermic and hypothermic oxygenated technologies to preserve organs so more transplants can be performed successfully.

Following Giamarelos’ landmark surgery last year, hospital staff successfully performed another double transplant in which both organs were perfused before being transplanted.

The technology has been used in more than 200 transplants since it was introduced to the hospital. In some cases, the hospital perfuses organs before sending them to other transplant centers in Australia to save lives.

Victoria faces critically low organ donation registration rates; Only 23 per cent of eligible people registered as organ donors, compared to the national state average of 36 per cent and South Australia’s 72 per cent.

“This all really depends on the generosity of the families,” Starkey said.

“The real heroes of the story are the secret, anonymous donors and their families.”

Giamarelos is keenly aware that a family somewhere in Australia has lost a loved one in exchange for being given a second chance.

“I’m so grateful to that family for making that decision at one of their worst moments,” he said.

“This is the most amazing thing. They give people like me a second chance at life.”

He wants to make the most of his second chance. He loves playing football in the park again with his 16-year-old son, Jordan, and plans to travel abroad with his family to the United States and take a cruise to Mexico this year.

“When something like this happens, you learn not to take any moment for granted,” he said.

To learn more about organ donation when visiting Australia DonateLife.

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