14 hours of operating time, 10 plastic surgeons, 4 orthopedic surgeons, 6 anesthesiologists and a team of 25 people including many scrub nurses. These are the record numbers that reflect the complexity of the double forearm transplant carried out on a 34-year-old man on September 25, 2021, at the Amrita Institute of Medical Sciences (AIMS) in Kochi, India.
For the first time in the world, this double upper limb transplant was performed using HEMO2life®.
The Indian teams approached Franck Zal, founder and CEO of Hemarina, after reading an article in The Lancet on the second facial transplant carried out on Jérôme Hamon, by Professor Laurent Lantieri’s team, at the Georges Pompidou European Hospital, also using HEMO2life®.
Today, one in every two grafts is lost as a result of preservation and oxygenation problems. 250,000 people around the world, 26,000 in France, are currently waiting for an organ donation for all kinds of grafts.
“HEMO2life® completely changes the transplant paradigm, which is now no longer an emergency process. From now on we will be able to carry out extremely long and complex operations, without watching the clock all the time, simply because this molecule allows the graft awaiting transplantation to breathe, sometimes for up to 48 hours,” Franck Zal, founder and CEO of Hemarina.
In the 1990s, Franck Zal completed a marine biology thesis on how marine worms colonize extreme environments, particularly beaches. He discovered the arenicola marina, a lugworm that has existed for 450 million years, whose hemoglobin is the ancestor of our current red blood cells. This hemoglobin binds 40 times more oxygen than the hemoglobin of a vertebrate. At low tide, this lugworm stops breathing and lives on the stock of oxygen it fixed when it was under water.
Over the years and as a result of meetings he had, Franck Zal realized that this discovery could have invaluable applications in medicine. “The arenicola is like a ‘universal blood donor’,” he explained.
The high tide/low tide cycle is similar to the ischemia-reperfusion issue in medicine. When a graft disconnected from a donor is no longer oxygenated, it is similar to the arenicola at low tide living on its oxygen supply. By bringing this graft into contact with the hemoglobin of the arenicola, which is highly charged with oxygen, it provides it with sufficient physiological oxygen for it to survive, even when disconnected.
In the Indian case, for example, the transplanted upper limbs recovered normal metabolic activity after ten minutes, instead of an average of one hour without HEMO2life®.
In 2016, a clinical trial in the area of kidney transplantation was carried out on 120 people. The kidneys preserved using Hemarina’s technology recovered almost immediately after transplantation, while the others took several weeks. Four years later, the survival rate of the transplanted patients was 98.3% compared to 86% with the traditional method.
A new trial is currently underway on 460 patients in several French hospitals, including one in La Réunion.