A donated heart is examined and perfused with blood while being prepared for transplant; this new technology resuscitates a stopped heart, keeping it pumping outside of the body until it can be transplanted into a waiting patient. — TNS
For the first time in Illinois, United States, surgeons have successfully taken a heart that stopped beating inside a patient and transplanted it into another person with the help of a new, science fiction-like device.
Surgeons at Northwestern Memorial Hospital announced last week that they performed a heart transplant in mid-October using a machine nicknamed “heart-in-a-box.”
It’s an advance that doctors hope will make more hearts available for transplant. About 3,400 people in the US are now waiting for heart transplants.
Usually, hearts are only considered for transplant if a donor suffers brain death, but the donor’s heart is still beating in their body, either on its own or with mechanical assistance.
That can sometimes happen after a traumatic injury or drug overdose.
In those cases, the heart is removed from the donor’s body and put on ice for transport to a recipient, which must occur within about four hours.
The heart-in-a-box device, however, allows surgeons to use hearts from donors who suffer circulatory death, which is when the heart and respiratory system shut down.
After the heart stops beating, surgeons have about 30 minutes to retrieve it and place it in the device. The device then resuscitates it and keeps it beating by pumping warm, oxygenated blood through it, until it can be transplanted into a donor.
The patient who received the heart at Northwestern is doing well, and was preparing to go home early this week, said Dr Benjamin Bryner, associate director of heart transplantation and mechanical support, and director of the expanded donation programme at Northwestern Medicine’s Bluhm Cardiovascular Institute.
“I think it’s one of the most significant advances in heart transplant in a few decades,” Dr Bryner said.
“It opens up a lot of hearts that were sort of discarded.”
He estimates the device could increase the number of heart transplants by about 20% to 30% at Northwestern and across the country.
Northwestern now performs about 30 to 40 heart transplants a year, Dr Bryner said.
Until now, patients usually could not be considered as potential donors unless they were brain-dead, limiting the number of hearts available.
The new technology allows surgeons to take hearts from patients who are not technically brain-dead but have no hope of recovery.
Those patients may also have suffered a traumatic injury or drug overdose, and have lost nearly all brain function, but aren’t considered brain-dead because they may have a reflex still intact or a small trickle of blood flow into the brain, Dr Bryner explained.
They’re not considered as donors unless there’s no hope left, he said.
If a patient reaches that point, the patient’s family can make a decision to take the person off life support, so they stop breathing and their heart stops beating.
The person then suffers circulatory death, and surgeons can retrieve the heart and place it in the device to be transported to another patient.
Extra time
Because the device keeps the heart pumping, surgeons have more time to transplant it than with traditional methods.
The device can keep the heart viable for eight or nine hours, compared with about four or five hours when a stopped heart is on ice before a transplant.
“With the traditional methods we’re limited in terms of amount of time and distance we can travel,” said Dr Duc Thinh Pham, director of the institute’s heart transplantation and mechanical circulatory support. “This device allows us to travel farther distances and for (a longer) travel period.”
The device also gives surgeons more time to examine a heart’s condition, searching for signs of injury or coronary artery disease, before it’s transplanted into another patient.
“Before, it was too big of a risk to take a heart that had already stopped out of someone and implant it and hope it would work,” Dr Bryner said.
Only a handful of US hospitals have used the technology to perform heart transplants, though hospitals in the United Kingdom and Australia have been using it for years, according to Northwestern.
The technology is similar to those that have been used to transplant livers, lungs and kidneys in recent years, including in the Chicago area.
The new portable device is called a TransMedics Organ Care System Heart System and was recently approved by the US Food and Drug Administration for use with organs from donors after circulatory death.
A paper published in the journal Cureus earlier this year noted that the technology has the potential to increase the number of hearts available for transplantation but is expensive and can be more complex to transport than hearts preserved using ice.
Dr Pham called the device one of the biggest developments that he’s seen in heart transplantation and said it could benefit more patients with heart failure.
He also urges people to sign up to be organ donors. – TNS
