Recent research shows that there may be a way to use more hearts for transplants even after someone has died. This technique involves restarting the blood flow to the heart, lungs, and other organs of individuals who had been gone for at least five minutes, but not to the brain.
Scientists are trying a new way to increase the number of available donated hearts for people who need heart transplants, which could raise the numbers by up to 30%. In 2021, over 8,400 heart transplants were reported in 54 countries. However, there were still over 20,000 people waiting in line for a donor heart and almost 1,500 deaths resulting from not having access to one. Unfortunately, many others got too sick before they could have their transplant done.
John Louca, a medical student in his last year at Gonville & Caius College of the University of Cambridge, said: “Having a heart transplant can help people who have severe problems with their hearts. On average, those people will live another 13 to 16 years if they get one. The major issue is that there aren’t enough donor hearts for everyone – so lots of people die waiting to get one.” He highlighted that it’s important to find new ways to use more available donor organs.
The first ever successful heart transplant was done at the Groote Schuur Hospital in Cape Town (South Africa) back in 1967. It was from a donor who had stopped receiving oxygenated blood, but this technique got replaced by using hearts from donors who were declared dead due to their brain not working anymore. So, in other words, these donors have been confirmed dead because their brains aren’t functioning and this type of donation is called ‘donation after brain death’ (DBD).
Until not long ago, people who wanted a heart transplant needed to get their new organ from a person who recently died but hadn’t been injured or ill. Recently though, thanks to lots of research in Cambridge, scientists have figured out how to use hearts from people who passed away after they got sick or hurt. Now those kinds of hearts can be used for transplants too!
DCD stands for donate organs after death, which is when a person who has a severe illness and can’t be saved anymore donates their organs. They are usually unconscious in a hospital’s intensive care unit and needing breathing support. In such cases, doctors and nurses talk to the patient’s family to decide if they should donate the organs. If so, then the process begins.
After a person dies, their heart stops beating and starts to become damaged. This damage becomes permanent after 30 minutes which makes the organ unusable for transplantation. To avoid this, doctors keep it in a machine called the Organ Care System (OCS). In this machine, oxygenated blood is pumped through the heart and examined if it can still be used.
A hospital in Cambridge, England was the first place to do a heart transplant using a special technique in 2015. Since then, they have become the most experienced and best at doing this type of transplant all around the world.
Also, Australia, Belgium, The Netherlands, Spain and the U.S started performing similar transplants at the same time. In 2021 alone, 295 of these types of heart transplants were completed in those six countries combined!
Organ Care Systems are very expensive, costing around $400,000 for the machine and an extra $75,000 for items needed to perfuse the organ. A cheaper way of doing this is called thoraco-abdominal normothermic reperfusion (taNRP). This involves perfusing the organ while it’s still inside the donor’s body and only costs about $3,000. It was first used in 2016 by a team of doctors at Royal Papworth Hospital.
Scientists from around the world did a study comparing transplanting hearts from donors that had brain deaths (DBD) to those with a non-heart beating donor caused by cardiac arrest (DCD). 157 DCD donor hearts and 673 DBD heart transplants which are “the gold standard” were looked at. The team involved 15 major transplant centres in the UK, Spain, USA and Belgium.
The team discovered that the number of heart transplantations that were performed increased by a total of 23%, thanks to the taNRP system which made more donors available.
Mr Stephen Large, a doctor at Royal Papworth Hospital, said that it can be hard for both families and doctors when they need to decide whether or not to turn off life support from the patient. But they try their very best to honor what the donor wants. Right now, out of every ten hearts that are taken out, one of them is rejected. But if we try to repair the heart in its place, then more people will get donated hearts.
Researchers found that the same number of patients survived for more than 30 days and at least a year after receiving a donor heart transplant, no matter if it was a death donor (DBD) or a donation after cardiac death (DCD) heart. After five years, 84% of patients were still alive who got donate hearts under both situations.
Professor Filip Rega, Head of Clinic at the Department of Cardiac Surgery, UZ Leuven in Belgium commented: “Our research gives hope that those people who need transplants to survive can now have the chance to receive it.”
Researchers think that taNRP can be beneficial due to the fact that the heart was not without oxygenated blood for as long. This time is called its warm ischaemic time, and it can average at 16.7 minutes compared to 30 minutes which could cause real damage to the heart cells.
This method has a nice advantage. It lets doctors keep multiple organs, like the liver, pancreas and kidneys, alive without needing many separate machines to do it. That makes it easier to do and cheaper too.
Professor Ashish Shah, a doctor from Vanderbilt University Hospitals in Nashville, USA who does heart surgery, said that working together across different countries can help people save hearts. He thinks this research will not only help us with transplanting hearts but also give us more knowledge about how we can rescue all hearts.
Dr Beatriz Domínguez-Gil, Director General of the National Organisation of Transplantation in Spain, said: “This study gives a lot of hope to many people who need a heart transplant each year all over the planet. Its findings reveal that if DCD transplantation is used with taNRP technique, it can bring results that are as good as the gold standard and also increase available hearts for transplant which will help health systems to stay sustainable.”
John Louca and other medical researchers from all around the world have studied a special type of heart recovery called In-Situ Recovery (or DCD). This study was published in eClinicalMedicine journal on 2nd March 2023. The research team included people such as Ashish Shah, Francisco González Vilchez, Iris Garrido, Mario Royo-Villanova etc. Their aim was to understand DCD better and how it could help with heart problems.
Reference: “The international experience of in-situ recovery of the DCD heart: a multicentre retrospective observational study” by John Louca, Marco Öchsner, Ashish Shah, Jordan Hoffman, Francisco González Vilchez, Iris Garrido, Mario Royo-Villanova, Beatriz Domínguez-Gil, Deane Smith, Leslie James, Nader Moazami, Filip Rega, Janne Brouckaert, Johan Van Cleemput, Katrien Vandendriessche, Vincent Tchana-Sato, Diawara Bandiougou, Marian Urban, Alex Manara, Marius Berman, Simon Messer and Stephen Large on behalf of WISPG, 2 March 2023, eClinicalMedicine.
DOI: 10.1016/j.eclinm.2023.101887
