Revolutionary Heart Transplant Technique Offers More Patients a Chance at Life-Saving Surgery

A new study conducted by Duke Health reveals that using a different approach for heart transplantation could deliver similar success rates as the usual method that mostly depends on donors who are brain-dead, and it could lead to a 30% increase in donor hearts available for use in transplants.

The difference is utilizing “donation after circulatory death” method, which has been in use for a while as a means of recovering organs like kidneys but not hearts normally, which are more delicate.

The research, led by Dr. Jacob Schroder, a transplant surgeon at Duke University School of Medicine, suggests that this method could increase the number of donor hearts available for lifesaving procedures and provide hope to thousands of patients.

According to Schroder, if more institutions adopted this method, the number of donor hearts could increase even more. The regular method of organ donation is a process of thorough testing to determine the absence of brain functioning when someone has had catastrophic brain injuries. The body is left on a ventilator that keeps the organs, including the heart, oxygenated to facilitate donation.

The study evaluated the use of DCD (donation after circulatory death) hearts in heart transplant procedures. DCD hearts come from individuals who have sustained a non-survivable brain injury, but their heart has not yet stopped.

The family then decides to withdraw life support and the heart stops beating. In the past, surgeons were hesitant to use these hearts for transplant due to concerns about potential damage from lack of oxygen. However, a new machine can now “reanimate” the heart by providing a supply of blood and nutrients during transport, allowing surgeons to assess if the heart is viable for transplant.

The study involved 180 heart transplant recipients, with half receiving DCD hearts and half receiving hearts from brain-dead donors that were transported on ice. The study found that survival rates six months after transplant were similar for both groups, with a 94% survival rate for DCD donations and a 90% rate for the usual donations. This new approach to heart donation has the potential to increase the number of viable organs available for transplant.

Dr. Nancy Sweitzer, a transplant cardiologist from Washington University in St. Louis who did not participate in the study, wrote an editorial in the New England Journal of Medicine stating that the findings are exciting and have the potential to increase fairness and equity in heart transplantation.

This new approach can allow more people with heart failure to have access to life-saving therapy, which is a positive outcome. The ability to reanimate DCD hearts and evaluate their viability for transplant can increase the pool of available organs, making it possible for more patients to find a match and receive a transplant. This could lead to more positive outcomes for patients on transplant waiting lists, increasing their chances of survival and improving their overall quality of life.

In the United States, a record number of 4,111 heart transplants were performed last year. However, this is still not enough to meet the growing need for heart transplants. Hundreds of thousands of people suffer from advanced heart failure, but only a small percentage are offered a transplant. Moreover, many individuals die while waiting for a suitable donor organ.

The use of DCD hearts for transplant has the potential to significantly increase the pool of available organs and help address this issue. It is hoped that this approach will become more widespread and will ultimately save more lives.

DCD heart transplants were first attempted by researchers in Australia and the UK about seven years ago. In the US, Duke University was one of the first hospitals to pioneer DCD heart transplants in late 2019. Currently, about 20 hospitals in the US offer this method.

Last year, there were 345 DCD heart transplants performed in the US, and so far this year, there have been 227, according to the United Network for Organ Sharing. This represents a growing trend in the use of DCD hearts for transplant, which has the potential to significantly increase the number of viable donor organs available for those in need of a heart transplant.

The Duke-led study showed that almost 90% of the DCD hearts recovered were used for transplantation, indicating that it is worth implementing this new method in more hospitals. Dr. Nancy Sweitzer noted that many potential donors have severe brain injuries but do not meet the criteria for brain death, which means that many viable hearts are never donated.

However, she cautioned that there is still much to be learned about this approach, and the sickest patients on the transplant waiting list were less likely to receive DCD hearts in the study.

Dr. Schroder added that many of the patients who received DCD hearts already had implanted heart pumps, which made the transplant more challenging, even if they were not ranked as high on the waiting list. The study was funded by TransMedics, the company that produces the heart storage system used in the study.

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