The tension in the air that night was palpable.
It was 1 a.m. and Dr. Shaf Keshavjee was on the roof of Toronto General Hospital, nervously awaiting a special delivery. A small group of people stood alongside him. A camera rolled. No one spoke.
Then, they saw it. A small, flashing light whizzing through the air, headed straight for them. That small flashing light was a drone, and riding on it was not only a pair of lungs about to save someone’s life, but also the chance to advance lung transplantation the world over.
“It comes over Toronto General and it kind of stops and hovers, and it’s probably only three or four seconds. But it seemed like an age and I’m thinking, ‘Just come down,’ you know,” Keshavjee recalls to Global’s current affairs program, The New Reality.
When the drone finally landed on the roof and the lungs were retrieved, Keshavjee called down to the operating room: They’ve arrived, we’re coming down.
That call was the last thing 63-year-old Alain Hodak remembers of that night, as he lay downstairs on an operating table. Hodak, in the throes of advanced pulmonary fibrosis, had just weeks to live.
Cheers erupted on the roof. Keshavjee hugged the project’s lead engineer.
Toronto: A centre for lung transplant excellence
Months have passed since that night. But the pride in Keshavjee’s voice when he speaks about what was achieved remains.
After all, it was a critical step towards what he sees as the future of the way organ transplants take place across the world — via specially made drones and “lanes in the sky.”
And he believes Toronto will play a major role in making that a reality.
Keshavjee, the director of the Toronto Lung Transplant Program at University Health Network (UHN), is something of a rockstar in the lung transplantation world.
His passion for lungs emerged as a student at the University of Toronto in 1983, when the first successful lung transplant in the world was performed at Toronto General. In 1986, he participated in the world’s first successful double-lung transplant at the same hospital.
“As a young student it hit me that, wow, it really is a miracle, but it’s extremely risky. It doesn’t really work that often. And so it really showed that there’s a lot of work to be done in the research to try and make it safe, make it available to more people,” Keshavjee says.
Lung cells start to die within 20 minutes, meaning preservation of the organ for transplant is tricky.
It’s why Keshavjee invented the Toronto Ex Vivo Lung Perfusion System in 2008 — a dome-like technology that not only preserves lungs for donation for longer, but can actually repair and restore them to make them more viable for transplant and less likely to be rejected by the recipient.
“We’re looking at taking lungs to 36 hours to 72 hours outside the body. That means you get a lung on Friday and you can book it for Monday morning — and … actually could be made better by Monday morning.”
It’s for these reasons that Toronto General was chosen to receive the first lung delivery by drone.
Why transporting organs is so difficult
Organ delivery is a time-consuming and costly process. A private jet must transport them by air to a local transport, and then by road to a hospital — a lengthy process easily delayed by traffic, personnel and logistical issues.
Furthermore, different teams must deal with different organs and staff are usually on standby and must be called in the moment a viable donor becomes available.
Drones, however, can travel directly from hospital to hospital. The hope is that one day, a drone could fly to a city hundreds of kilometres away to deliver an organ to a patient in need.
The concept first saw success in 2019, when the first drone organ delivery took place in Baltimore, with a kidney transported to the University of Maryland Medical Centre. In September 2020, corneas and kidneys were delivered in Nevada, and in Minnesota, a successful pancreatic delivery happened by drone.
But this was a world first for a set of lungs.
“They’re the most fragile and the most challenging of the major organs,” Keshavjee says.
Which meant the need for a purpose-built drone.
Keshavjee worked with Bromont, Que.-based Unither Bioelectronics for 18 months to come up with a concept that was up to the task.
The winning design was a smaller-sized proof of concept of Unither’s semi-autonomous drone, which is carbon-fibre, fully electric and has a 25-kilogram takeoff weight — the maximum that Transport Canada allows.
The carrier system was temperature-controlled and designed to protect against drops and vibrations.
Of course, there were logistical issues that needed to be considered. Wind can be unpredictable around tall buildings. There’s a higher chance of GPS interference. What if a strong wind blows it off course? What if it fails mid-flight and crashes to the ground in the middle of a busy city, potentially maiming a pedestrian?
With that in mind, Unither developed a special navigation system that couldn’t be interfered with and kitted out the drone with a ballistic parachute.
“If the drone dropped too fast, tilted suddenly or loses power, it will cut all the engines and the parachute will fire and the drone will come down to the ground safely,” Keshavjee says.
With the courier finalized, the team needed someone in need of a pair of lungs — and game enough to receive them in such an experimental way.
‘I was really at the end of the line’
In August 2021, Alain Hodak was fast running out of options.
The Ottawa resident was diagnosed with pulmonary fibrosis in January 2019. His condition continued to deteriorate until early 2021, when he was told his only option was a lung transplant.
Hodak was placed on the waiting list and rented a condo in Toronto to be close enough to the hospital, should a donor organ become available.
“I was really at the end of the line,” Hodak says.
“I was on major quantities of oxygen just to get up to walk around. It was totally unbearable.”
Hodak first heard about the drone delivery concept at a support group and was later approached at Toronto General by Keshavjee, who asked if he was interested in participating.
Being an engineer by trade and a lover of drones himself, he jumped at the chance.
“I said, ‘I’m a technical guy. I’m an engineer by profession. Advancement of science? Sure, I’ll participate.’”
At that stage, Hodak says he was operating at 10 per cent lung capacity and had only a few weeks to live.
“It’s almost like the stars lined up.”
A historic six-minute flight
By early September, everything was set. The drone had undertaken 53 test flights between Toronto General and Toronto Western, where the lung would be transported from.
At just after midnight, the donor lung was filled with oxygen, set at the correct temperature and placed inside the drone container.
Keshavjee took up his position on the roof of Toronto General with the head of his engineering team.
“Basically, they just push a button and it goes up, goes across and comes down on the General,” Keshavjee says.
The 1.5-kilometre journey lasted just six minutes.
Hodak remembers being told the lungs had arrived and the next moment, he was waking up from surgery.
“(When I woke up) I could breathe in, and I knew that I had the lungs and the feeling of waking up was, it was just amazing,” Hodak says.
Two days later after his transplant, he was well enough to attend his daughter’s wedding, albeit virtually, from his hospital bed. It was a milestone for Hodak, who had missed his son’s wedding just weeks earlier because he was too weak to attend.
He’s now looking forward to being able to play with his grandchildren without the need for oxygen. His first arrived in December, a granddaughter, and the next is due in August.
“I was given a second life. Really, that’s what it basically is, thanks to a generous donor. I now have a second life.”
By 2025: A drone that could travel 460 kilometres
There is obviously a long way to go before we exist in a world in which dozens of drones whizz overhead throughout the day, delivering life-saving organs across the country.
But Keshavjee is adamant that this is the future: a world in which the capacity for transplants is ramped up because drones can deliver the organs faster and cheaper. He believes “organ transplantation can be like a hip replacement.”
“You go in, get a new hip. You go home. You go in, get a new lung, you go home,” he says.
That world might not be so far away.
Unither’s VP of program management for organ delivery systems, Mikael Cardinal (who was also the recipient of Keshavjee’s hug the night of the delivery), says the Toronto drone was a “stepping stone” to help the company develop its larger aircraft that can perform the same organ delivery missions across longer distances, with a larger payload.
With advances in battery technology, Cardinal estimates that by 2025, they’ll have developed a drone that can travel about 460 kilometres.
But to do so, supporting infrastructure will need to be built. That means strategically placed charging systems at hospitals and airports and updated civil aviation regulations.
The larger drones will initially be piloted, but as regulatory framework is updated, the drones will be autonomous — operated from a centralized monitoring command and control centre where “one or two operators could monitor 10 to 15 drone aircraft all at once,” Cardinal says.
Drone delivery is also cheaper. Often, organ deliveries require sets of dedicated teams for each organ, Keshavjee says, and staff are often on standby, being called in the moment an organ becomes available.
“One donor hospital will have five teams and five planes coming from five different places, to pick up their organ and go back to their hospital. (That’s) five more plane trips just to transport an organ that weighs two kilograms,” he says.
With drone transplant and his Ex-Vivo system used in unison, transplants could not only be scheduled for certain times, but also save money in the process.
This efficiency could also help cut down waiting list times.
“People live on the lung transplant list knowing that one in five of them will die before they can get a lung in time,” he says.
“The vision is bigger than just the transplant patient in the operating room. It really is how to make a system work better.”
One day, Keshavjee hopes that system will include dedicated lung transplant hospitals and a regulated drone delivery system.
And Toronto — the city that heralded the first successful lung transplant four decades ago — together with Unither, will continue to lead the charge in pioneering transplant technology.
“I think there’s likely going to need to be lanes in the sky where drones go, and I think all of that needs to be figured out.
“But organ transplantation is probably a pretty important reason to really figure that out — rather than delivering your laundry detergent.”
See this and other original stories about our world on The New Reality airing Saturday nights on Global TV, and online.
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