The last thing Alain Hodak remembers before his double lung transplant surgery was excitedly waiting in the operating room for a call from a doctor on the roof of the hospital, saying his drone had arrived.
That drone carried a pair of lungs 1.5 kilometers across downtown Toronto in a world-first delivery that Hodak had eagerly agreed to be part of in September.
An engineer by trade and a lover of drones, 63-year-old Hodak proved the ideal patient for the world’s first transplant of lungs delivered by an unmanned drone, completed by University Health Network (UHN) and Unither Bioelectronique.
The lungs travelled in a purpose-built drone from Toronto Western Hospital to Toronto General Hospital — a journey that lasted just six minutes, but could change the future of organ delivery.
And Hodak is proud to be the guinea pig. The Ottawa resident was diagnosed with pulmonary fibrosis in 2019 and says, before the surgery, trying to breathe was “unbearable.”
“Having no air, I was on oxygen in industrial quantities of 25 litres a minute of oxygen, which is pretty much as much as you could put in. And now I’m able to breathe, and I’m almost sometimes surprised about breathing,” Hodak told CBC News.
Hodak’s condition deteriorated in early 2021 and he was told his only option was a lung transplant. He was placed on the waiting list and rented a condo in Toronto in June with his wife to be close enough to the hospital, should a donor organ become available.
“It was a race against time,” Hodak said.
Drone delivery trials were underway
Meanwhile, Dr. Shaf Keshavjee, the Director of the Toronto Lung Transplant Program at UHN, was trialling the delivery of organs by drone. Keshavjee said he had been studying organ preservation for transport “all my life.”
“We’ve used planes and helicopters and cars and vans, and oftentimes there’s a challenge in logistics. But it seems not right to use a whole Learjet to transport something that weighs only two kilograms,” said Keshavjee.
“Flying a drone in this city is [challenging], because it’s a populated area with a lot of radio frequency interference and also [lots of] people around. So if you can fly a drone in this city, then you can fly a drone anywhere.”
Keshavjee said they had to seek “a lot” of permission for the drone flight to take place, including from Health Canada and Nav Canada.
The team undertook 53 test flights between the two hospitals and had to develop a navigation system “that would not be interfered with.”
“We had a ballistic parachute on the drone so if anything went wrong with it, if one of the engines failed, if it tipped too suddenly or it dropped too fast, it would cut the engines, blow the parachute out and the drone would come down to Earth slowly,” Keshavjee said.
When everything was ready, Keshavjee informed patients on his waiting list about the pilot project.
“I was with my daughter when they came to us and told us the lungs were available and there was this project that the doctor was working on. And we said, ‘Absolutely, yes. I’m an engineer by trade and I love technology,'” Hodak said.
“I wanted to do it for technical reasons and the results of advancing the science.
“And it’s obviously very, very important to me because [the drone] was bringing me the lungs that saved my life.”
‘The lungs arrived, we’re coming down’
In late September, the donor lung was taken to Toronto Western and prepared for flight in the carbon-fibre drone. The lungs were filled with oxygen and set at the correct temperature inside a cooler box inside the drone.
Keshavjee was “nervously” awaiting the delivery on the roof of Toronto General. He would perform the transplant himself.
Hodak still remembers the night clearly. It was 1 a.m. and he was waiting in the operating room with another doctor.
“[The doctor] came next to me and said the lungs are on their way. And then he was on the phone with Dr.Keshavjee upstairs on the roof and he said ‘The lungs arrived, we’re coming down’.
“And then I closed my eyes and I took a breath and I woke up. And I said ‘I can breathe, this is weird.'”
But the world-first didn’t only allow Hodak to breathe again, it also allowed him to attend his youngest daughter’s wedding; albeit virtually. Hodak’s daughter was married two days after his surgery. He had missed his son’s wedding in August due to his health.
“Ten hours later, I was waking up and I was able to participate in the wedding. It was like almost a miracle wedding gift,” Hodak said.
Three weeks on, Hodak says he feels “amazing” and is still “shocked” that he’s able to breathe.
Drone organ delivery could be the future
Keshavjee believes the drone delivery could be a watershed moment for organ delivery worldwide.
While organs must usually be transported via air to a local airport, and then transported by road to a hospital, this delivery method eliminates the need for airports altogether. The automated process also meant there were no delays, less transport or logistical issues and no need for pilots — who also needed to be changed if there was a “time out” in the delivery process.
Keshavjee said the next step is to test the system out with bigger drones that have longer ranges and can travel longer distances. This would allow them to “slowly expand the distances and address the regulatory issues.”
“It’s one thing to have one drone flying in downtown Toronto but what do you do when there’s 50 flying around?” he asked.
However, once regulations are in place, Keshavjee is confident that organ delivery by drones will “become routine.”
“We could send a drone to Calgary to pick up a lung and send it back. If we have the networks to retrieve organs and preserve them properly, I see the future being transporting organs to an organ repair centre first so that … organs are optimised and prepared and then flown again to the recipient hospital,” he said.
“I think this is just the beginning.”