‘Liver in a box’ helps save more lives, can improve transplant outcomes

Jennifer Rosoff, 60, of Portland, underwent a liver transplant on May 23, 2023, at OHSU. Her new liver came from a donor located multiple hours away, which would not have been an option for her without a perfusion pump. A perfusion pump flows blood through a liver as much as 24 hours before transplantation instead of the traditional approach of chilling donor organs in ice and rushing to transplant them. OHSU is the only Oregon hospital that uses perfusion pumps for liver transplantation. (OHSU/Christine Torres Hicks)

Oregon Health & Science University is the only hospital in Oregon and one of just two Pacific Northwest hospitals that use a new medical device that has been nicknamed a “liver in the box.”

Seven OHSU patients have undergone transplants since April thanks to the device.

Before the FDA approved two similar devices in 2021, transplantation always involved draining a donor liver of blood, chilling it on ice, and rushing to transplant it within a narrow, six-hour window. Now, trained transplant teams have another option: connecting a donor liver to a perfusion machine that flows blood through the organ at normal body temperature.

Livers can safely be connected to perfusion pumps for up to 24 hours before being transplanted, providing more valuable time to transport organs greater distances and to better assess the suitability of an organ before transplantation. As a result, more livers that would otherwise be too logistically or technically challenging to transplant can be used — optimizing precious resources and saving lives. 

Kristian Enestvedt, M.D., FACS (OHSU)

“Transplant demand has sadly always exceeded available organs,” said OHSU Liver Transplant Surgical Director Kristian Enestvedt, M.D., FACS. “When you know patients on the liver wait list aren’t going survive without a transplant, it’s heart-wrenching to have to turn down a potential donor liver because it’s too far away or because you don’t have enough time to evaluate it. Now, perfusion pumps are helping more patients get much-needed transplants.”

While a record 9,528 liver transplants were performed in the United States last year, the Organ Procurement & Transplantation Network — the public-private partnership that connects U.S. organizations involved in transplantation — reports that 1,041 Americans died while waiting for a new liver in 2022.

On top of the 58 livers that OHSU transplanted in 2022, the university expects to perform about a dozen more liver transplants each year with the device. If 12 additional transplants occur annually, OHSU could increase its total number of liver transplants by about 20%.

‘Best shape possible’

Alexandra C. Bolognese, M.D. (OHSU)

OHSU patient Jennifer Rosoff, 60, of Portland, had been on the liver transplant wait list for about two years. That is, until May 23, when Enestvedt and fellow OHSU surgeon Alexandra C. Bolognese, M.D., Ph.D., performed a transplant that resulted in Rosoff receiving a donor liver after it had been on a perfusion machine for 12 hours.

Although she’s 5-feet-8-inches tall, Rosoff has a small abdominal cavity. That means she also needs a small liver, and it was a challenge to find a right-sized organ to match her. The donor liver that Rosoff eventually received traveled multiple hours — and would not have been an option without the perfusion pump.

“This device means that I was able to receive a liver that is in the best shape possible,” Rosoff said. “My attitude throughout this journey has been that all will be provided at the right time. I feel like all the circumstances in the universe came together at once in May — including a perfusion pump being available for my liver transplant.”

Rosoff needed a new liver after her bile ducts — which move the food-digesting fluid bile from the liver to the gallbladder — were damaged during a 2020 surgery to remove neuroendocrine tumors from her liver. While she waited for a donor liver, Rosoff had to wear external bile drains that she emptied twice a day. Because bile wasn’t going through her intestines, she absorbed fewer nutrients from food and lost about 30 pounds. Rosoff was also hospitalized more times than she can count — including once for sepsis, a body-wide, life-threatening infection.

A second chance

“It’s really nice not being a patient right now,” said Rosoff, who is once again gardening at home and taking her dog for daily walks. She also recently returned to work on an on-call basis.

Rosoff is a physical therapist at Kaiser Permanente Sunnyside Medical Center, where she helps parents bond with and better care for their critically ill newborns. Some babies she cares for have parents who are struggling with substance use disorders. While she was waiting for a liver, Rosoff began taking addiction counseling courses and even participated in remote video classes from the hospital. She recently completed a certificate in drug and alcohol counseling, and wants to use her new expertise to better support babies and their parents.

“It’s only been three months since I had my transplant,” Rosoff said, “but I feel like there’s something that I need to be doing and that I need to give back.”

Technologies like perfusion pumps are enabling more patients to have a second chance at life, but transplants can’t happen without organ donation. Rosoff hopes her story will inspire more people to become organ donors.

“It’s easy to sign up to be an organ donor, and it can make a huge difference in someone’s life,” she said. “It’s literally a life-and-death decision.”

Jennifer Rosoff, 60, of Portland, loves to walk her dog through the neighborhood. Rosoff underwent a liver transplant on May 23, 2023, at OHSU. Her new liver came from a donor located multiple hours away, which would not have been an option for her without a perfusion pump. A perfusion pump flows blood through a liver as much as 24 hours before transplantation instead of the traditional approach of chilling donor organs in ice and rushing to transplant them. OHSU is the only Oregon hospital that uses perfusion pumps for liver transplantation. (OHSU/Christine Torres Hicks)