A team of surgeons kept a critically ill man alive for 48 hours without a pair of lungs while he waited for a double lung transplant – a radical approach that could be used again for selected patients, they said.
The team from Northwestern University in the United States built a total artificial lung (TAL) system that oxygenates blood as our lungs usually do, while managing blood flow and protecting the heart.
The TAL was crucial in stabilising the patient and preparing him to receive a pair of donor lungs. More than two years on, the individual has recovered well – and has lungs that are fully working.
The story began in 2023, when the 33-year-old man developed influenza-associated lung failure. This rapidly progressed to pneumonia, sepsis, and what’s known as acute respiratory distress syndrome (ARDS).
“He developed an infection of his lungs that just could not be treated with any antibiotics because it was resistant to everything,” said thoracic surgeon Ankit Bharat.
“That infection caused his lungs to liquify and then continued to progress to the rest of his body.”
The standard approach would be to put the patient on a life support system and give the lungs time to recover. Here, though, the lungs were the main problem and source of infection: the man seemed certain to die if his lungs weren't removed, and very likely to die if they were.
Removing both lungs – a bilateral pneumonectomy – usually leads to the heart failing due to disruptions in blood flow.
To avoid that and overcome the limitations of previous attempts, the medical team behind the TAL added dual blood flow channels and a flow-adaptive shunt, allowing variations in blood flow to be evened out.
The machine was enough to keep the patient alive long enough for his body to recover sufficiently to make a lung transplant viable. Once the organs were removed, signs of recovery from the infection began.
Bharat and his team carried out a molecular analysis of the lungs after they’d been removed, confirming that there was no chance of the lungs recovering from ARDS of their own accord.
The scarring and immune damage meant that in this case, a lung transplant was absolutely necessary.
“Conventionally, lung transplant is reserved for patients who have chronic conditions like interstitial lung disease or cystic fibrosis,” said Bharat.
“Currently, people think if you get severe ARDS, you keep supporting them and ultimately the lungs will get better.”
This is an approach that could be used again to save more lives. While constructing a TAL system like this is currently possible only at specialised centres, Bharat hopes that the innovations applied here could be incorporated into standard devices in the future.
Whereas a double-lung transplant might previously have been considered impossible in this scenario, we now know it can be done and can be a success – and may be an option in future cases, though it still depends on timely access to donor lungs.
“In my practice, young patients die almost every week because no one realised that transplantation was an option,” Bharat added.
“For severe lung damage caused by respiratory infections, even in acute settings, a lung transplant can be lifesaving.”
A case report on the operation was published in Med.
Study details
Bridge to transplant using a flow-adaptive extracorporeal total artificial lung system following bilateral pneumonectomy
Yuanqing Yan, Anitha Chandrasekhar, Hee Chul Yang, Ankit Bharat et al.
Published in Med on 30 January 2026
Context and significance
Severe acute respiratory distress syndrome (ARDS) caused by drug-resistant infection is often fatal, and lung transplantation is rarely attempted because ongoing sepsis and organ instability make surgery unsafe. Here, we used a fully extracorporeal artificial lung to remove both lungs in a critically ill patient, eliminating the infection while maintaining life-sustaining oxygenation and circulation. Single-cell and spatial analyses of the explanted lungs revealed irreversible tissue destruction and aggressive fibrosis, supporting the decision to proceed with transplant. The patient recovered fully after surgery, demonstrating that this strategy may offer a lifesaving bridge to transplantation for selected patients who would otherwise have no treatment options.
Summary
Background
Severe acute respiratory distress syndrome (ARDS) complicated by necrotizing pneumonia and septic shock carries a mortality exceeding 80%. Lung transplantation is rarely pursued because persistent sepsis, uncertainty regarding the reversibility of parenchymal injury, and profound hemodynamic instability preclude candidacy.
Methods
We developed an extracorporeal total artificial lung (TAL) system to enable bilateral pneumonectomy for source control in a patient with ARDS complicated by necrotising pneumonia and refractory septic shock. The system incorporated a flow-adaptive right pulmonary artery-to-right atrial shunt to compensate for loss of pulmonary vascular capacitance, extracorporeal oxygenation, and dual left atrial return conduits to maintain physiologic transcardiac blood flow. In parallel, we performed single-cell and spatial transcriptomic profiling of the explanted lungs to define associated cellular and molecular changes.
Findings
Following pneumonectomy, vasopressor requirements resolved, and the patient remained fully supported until transplant. Transcriptomic profiling revealed diffuse, uniform destruction across all regions, with dense infiltration by neutrophils, monocyte-derived alveolar macrophages, and activated T cells. These inflammatory changes coexisted with marked expansion of aberrant basaloid epithelial cells and CTHRC1-positive myofibroblasts, with near-complete loss of normal alveolar architecture. Molecular signatures recapitulated end-stage fibrotic lung disease and were consistent with irreversible injury rather than a recoverable ARDS phenotype. The patient demonstrates excellent cardiopulmonary function two years after transplantation.
Conclusions
An extracorporeal TAL system can permit safe bilateral pneumonectomy for source control in otherwise non-transplantable patients with medically refractory pneumonia, providing a viable salvage strategy to bridge selected patients to successful lung transplantation.
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