Three state-of-the-art organ repair labs (ORLs) are now in use in UHN's Sprott Department of Surgery operating rooms at Toronto General Hospital. They are located within one of the busiest and most renowned surgical suites in North America, on the second floor of the Peter Munk Building.
The construction project, which took more than a year to complete in a 4,000-square-foot space, brings the next generation of care for transplant patients at UHN.
"These ORL suites are quite unique, two of them are dedicated to repairing organs with ex vivo systems, and a third is dedicated to cell therapies," says Dr. Atul Humar, Director of UHN's Ajmera Transplant Centre.
Ex vivo systems pump nourishing fluids through organs, enabling them to be warmed to body temperature, so that they can be repaired and improved before transplantation.
"There's a huge shortage of organs and several patients die on the waitlist. These ORLs will allow us to advance our techniques to increase utilization of organs," adds Dr. Humar, who is also a Professor in the Department of Medicine at University of Toronto.
UHN's Surgeon-in-Chief, Dr. Shaf Keshavjee, highlights that this project is particularly innovative as scientists and surgeons helped design the ORLs in partnership with the Facilities Management – Planning Redevelopment and Operations (FM-PRO) team at UHN.
"The very exciting thing about building these organ repair labs is being able to build them from scratch, and have them built to the specifications of scientists and surgeons who pioneered and developed ex vivo techniques," says Dr. Keshavjee, who is also Director of the Toronto Lung Transplant Program, the James Wallace McCutcheon Chair in Surgery, Director of the Latner Thoracic Surgery Research Laboratories and Professor of Thoracic Surgery at U of T.
"As much as we're defining how to do transplant, we're defining how to build a building for transplant. Other centres around the world are following us, using our specs to create their own ORLs."
Teamwork and hard work
To create these state-of-the-art ORLs, with the latest technological advances in transplant, surgery, and communications capabilities, it was critical to have a strong partnership with the construction team. The expertise from UHN's FM-PRO Department allowed construction to happen in a space where surgeries can't be put on hold.
"The biggest challenge was working in an active OR (operating room)," says Christopher Rizzo, Senior Director, Redevelopment, FM-PRO, who oversaw the construction.
"We had 20 active operating rooms, and we had to keep them active, so we're working in a sterile environment, with the main focus of keeping patients and staff safe," he adds.
"ORs are a high-traffic sensitive environment," explains Project Manager Munazza Siddiqui. "And it has to be sterile, so construction workers had to gown up to get to and from the site."
She explains converting what was formerly storage space into the new ORLs also required significant upgrades to ventilation and air filtration systems.
Munazza lists several high-demand steps of the work needed to bring the ORLs to life:
- A 20,000-pound air handling unit (a bigger and more complex version of the equipment you would see outside for a residential air conditioner) was crane-lifted to the roof of the hospital
- Ducts in the rooms were replaced
- The HVAC (Heating, Ventilation, and Air Conditioning) system was designed to maintain positive pressure in all three rooms
- High-end HEPA filters were installed to remove all particles from the air supplied to the ORLs
Innovation translated to improved patient care
The ORLs allow for increased capacity in ex vivo therapies, to assess and treat organs prior to transplant, as well as cell therapies, such as islet cell transplantation – transplantation of cells responsible for production of insulin in the pancreas.
One of the first patients to receive such a transplant, where islet cells were isolated in the new ORL, was 16-year-old Morgan Saunders. She travelled with her parents, Tom and Susan, from Winnipeg for this highly-specialized procedure.
Morgan had lived with debilitating pancreatitis – severe inflammation of the pancreas – since the age of nine. This procedure has put an end to painful crises that took her to hospital several times a year and kept her away from regular activities, such as attending school or going out with friends.
"I didn't get to fully experience part of my childhood and teenage years, as I missed so much time in school, with friends and family," says Morgan.
"I was very excited to get this surgery, as it represented finally a chance to get better. Now, looking back, I think it was 100 per cent worth it, probably the best decision I've ever made," Morgan said almost two months after the transplant, and not having experienced since any pain crisis.
"It is such a relief not to see our daughter coming to us crying, in pain anymore, because her stomach hurts. It was the best Christmas gift we could ever get," says Morgan's mother, Susan, about the surgery, which happened in December.
"Being able to do islet cell isolation and transplant 'in-house' within our own ORL suite at Toronto General is a real game-changer; we will be able to serve a lot more patients," says Dr. Trevor Reichman, Director of the Pancreas and Islet Transplant Program at the Ajmera Transplant Centre and Associate Professor of Surgery at U of T.
The construction of the ORLs was funded by generous donors to UHN Foundation, the Ajmera Transplant Centre and the Sprott Department of Surgery.
