Last year surgeons in Sydney, Australia pioneered a ground-breaking new technique that should increase the availability of viable donor hearts. In what was described as the biggest heart transplant breakthrough in a decade, two patients received hearts that had been restarted following the terminal cardiac arrest of donor circulatory death (DCD). Previously, hearts had to be taken from donors who had suffered brain death, but whose hearts were still beating, which severely limited the number of donor organs available.
This year, medics at Papworth Hospital in Cambridge, UK successfully carried out a heart transplant using the new procedure. The patient recovered rapidly, only spending 4 days in the hospital’s critical care unit, before being well enough to return home.
The new technique, which was first developed by researchers from St. Vincent’s Hospital in Sydney and the Victor Chang Cardiac Research Institute, can be applied to hearts that have stopped for as long as 20 minutes. First, the unbeating heart is restarted inside the donor’s body, where it is assessed for any problems using ultrasound over a 50 minute period. The heart is then removed from the donor and is kept beating, warmed and perfused with blood by an organ care system (a “heart-in-a box” machine) for up to 3 hours before transplantation.
As reported in the Guardian: Consultant surgeon at Papworth, Stephen Large, predicted that, “the use of this group of donor hearts could increase heart transplantation by up to 25% in the UK alone.” Notably, five other specialist heart transplant centres around the UK plan to adopt the procedure soon, which may reduce waiting times for heart transplant patients.
This development came just two years after the world’s first successful “warm liver” transplant in King’s College Hospital, London. Using the “OrganOx” organ support system (developed over a 15 year period by scientists at Oxford University), the liver was warmed to body temperature and kept perfused with blood. This system can keep the donated liver alive outside the body for up to 24 hours – twice as long as a liver kept “on ice” – which increases the time window available for donor-patient matching, transport and transplantation.
It seems that the old technique of keeping donor organs chilled prior to transplant will soon be superseded by these new warm “organ-in-a-box” methods, to the great benefit of patients.