Humans can’t live without lungs. And yet for 48 hours, in a surgical suite at Northwestern University, a 33-year-old man lived with an empty cavity in his chest where his lungs used to be. He was kept alive by a custom-engineered artificial device that represented a desperate last-ditch effort by his doctors. The custom hardware solved a physiological puzzle that has made bilateral pneumonectomy, the removal of both lungs, extremely risky before now.

The artificial lung system was built by the team of Ankit Bharat, a surgeon and researcher at Northwestern. It successfully kept a critically ill patient alive long enough to enable a double lung transplant, temporarily replacing his entire pulmonary system with a synthetic surrogate. The system creates a blueprint for saving people previously considered beyond hope by transplant teams.

Melting lungs

The patient, a once-healthy 33-year-old, arrived at the hospital with Influenza B complicated by a secondary, severe infection of Pseudomonas aeruginosa, a bacterium that in this case proved resistant even to carbapenems—our antibiotics of last resort. This combination of infections triggered acute respiratory distress syndrome (ARDS), a condition where the lungs become so inflamed and fluid-filled that oxygen can no longer reach the blood.

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© Yuichiro Chino

A crackdown on problems with fairness and safety is achieving results, including a big drop in the number of sick patients being passed over for transplants.

© Alyssa Schukar for The New York Times

After eight years of training, Dr. Maureen McKiernan made her debut as the lead surgeon on an infant heart transplant — an operation on the edge of what’s possible.

© Victor J. Blue for The New York Times