In what many doctors are calling a medical breakthrough, surgeons at Northwestern Medicine kept a critically ill patient alive for 48 hours after removing both of his lungs. The extraordinary effort gave doctors just enough time to eliminate a deadly infection and perform a life saving double lung transplant.
The case, published in the journal Med, opens a new path for patients who would otherwise be considered too sick to survive long enough for a transplant.
The effort was led by Ankit Bharat, chief of thoracic surgery and executive director of the Northwestern Medicine Canning Thoracic Institute. He worked with a large multidisciplinary team of transplant surgeons, critical care physicians, engineers, and ECMO specialists who remained at the patient’s bedside around the clock.
According to Dr. Bharat, the team faced a situation with no conventional options left.
“He was actively dying,” Bharat said. “Nothing else was working.”
Why the Patient Needed His Lungs Removed
The patient was a 33 year old man from Missouri who was flown to Northwestern Memorial Hospital in spring 2023. What began as influenza related lung failure rapidly progressed into severe pneumonia, acute respiratory distress syndrome, and overwhelming sepsis.
The infection was resistant to all available antibiotics.
“He had developed an infection of his lungs that just could not be treated with any antibiotics because it was resistant to everything,” Bharat said. “That infection caused his lungs to liquify and then continued to progress to the rest of his body.”
As the infection spread, the patient suffered cardiac arrest and required CPR. Doctors realized the lungs themselves had become the source of the infection and had to be removed to save his life.
Removing Both Lungs Is Normally Fatal
Lungs do much more than supply oxygen. They also regulate blood flow through the heart.
“The lungs act as a shock absorber for the right side of the heart,” Bharat explained. “When you remove them, the heart pumps against high resistance and can fail instantly.”
Without lungs, blood flow to the left side of the heart can collapse or form deadly clots. For this reason, removing both lungs without immediately replacing them has historically been considered unsurvivable.
The Technology That Made Survival Possible
To solve this problem, the team designed a custom total artificial lung system, or TAL. The system temporarily replaced key lung functions while also protecting the heart.
The device took over oxygenation and carbon dioxide removal. It redirected blood flow to prevent heart failure. It used a flow adaptive shunt that allowed the patient’s own heart to control circulation. It employed dual return tubes to maintain normal blood flow through the left heart.
“A key innovation here is that we maintained the heart’s natural physiology,” Bharat said. “We allowed the patient’s own heart to regulate blood flow, rather than forcing it with a machine.”
To keep the heart from shifting inside the chest after lung removal, surgeons also used temporary saline filled tissue expanders commonly used in reconstructive surgery.
Once both lungs were removed and the artificial system was activated, the results were almost immediate.
“Just one day after we took out the lungs, his body started to get better because the infection was gone,” Bharat said.
Within 48 hours, the patient stabilized enough to receive donor lungs. Surgeons then performed a successful double lung transplant.
More than two years later, the patient has returned to daily life.
“He has excellent lung function, his heart function is preserved and he is completely functionally independent,” Bharat said.
The donor’s identity was not made public, but doctors emphasized that the transplant would not have been possible without the generosity of the donor and the donor’s family. The team described the transplant as the final critical step that turned an experimental rescue into long term survival.
Researchers also conducted advanced molecular analysis of the removed lungs. Using single cell and spatial transcriptomic techniques, they found extensive scarring, immune driven damage, and near total loss of the cells needed for lung repair.
“These results explain why just providing support would not have helped the lungs heal,” Bharat said.
The findings offer biological proof that some ARDS patients will never recover lung function and need transplantation to survive.
Outside experts described the achievement as remarkable.
“It is difficult to maintain normal heart function in the absence of lungs,” said transplant clinician Natasha Rogers, noting that blood flow management has been the main obstacle in past attempts.
Doctors also emphasized that this approach requires extreme expertise and is not yet widely available.
What This Means for Future Patients
Patients with severe ARDS, necrotizing pneumonia, or septic shock often face mortality rates exceeding 80 percent and are frequently denied transplants because they are too infected.
“This technology allows us to clean the slate,” Bharat said. “We can remove the infection, stabilize the patient and bridge them to a successful transplant.”
In the future, researchers hope to develop durable implantable artificial lungs that could support patients long term, not just as a temporary bridge.
For now, this case shows that even when biology seems to have run out of options, innovation can still buy time and time can save a life.
