First beating-heart transplant gives hope for future patients

Surgeons have successfully kept a human heart alive and beating outside the body, in a medical advance that could extend life-saving heart transplants to scores more patients.

In the first successful beating-heart transplant performed in the UK, surgeons at Papworth Hospital in Cambridgeshire kept the organ pumping blood for five hours after removing it from the donor. The heart was taken from Addenbrookes hospital, where the donor died, to Papworth where it was transplanted into a 58-year-old man who was close to death.

The operation, performed a week ago, was a success and the patient, who has not been named, was "doing extremely well" on a normal ward, Professor Bruce Rosenguard, who led the research team, said.

"We are extremely excited by the possibilities this offers us. Papworth is one of only four hospitals in Europe taking part in this trial and, if the system continues to prove successful, it could significantly increase the number of donor hearts available."

The donor heart was kept in a specially designed Organ Care System, about the size of a tea trolley, while it was transported between the two hospitals. Once attached to the system, with plastic tubes inserted into its vessels, the heart was revived to a beating state and infused with oxygen and nutrient rich blood.

Five hours later, when it was transplanted into the eventual recipient at Papworth hospital, it was still as fresh as if it had just been removed.

Keeping hearts alive and beating after they are removed has been a goal of heart surgeons for years. Organs quickly deteriorate after being taken from the body and hospitals operate a limit of about four hours on using a non-beating donor heart.

That restricts the distance the organ can be transported and the time available to assemble a surgical team to carry out the transplant, which often happens in the middle of the night.

By extending the period during which the heart can be used, through keeping it alive and beating, the number of organs available for transplant and the number of potential recipients could be broadened. At the same time, surgeons will have the opportunity to assess the heart and test it for existing diseases. More extensive tissue matching may reduce the risk of rejection.

John Wallwork, transplant surgeon at Papworth, said: "The potential for this device is enormous but we have to prove it. Not only will we be able to transport hearts over longer distances, going into Europe but we can make heart transplants a daytime activity and we can assess the hearts before we transplant them. We may even be able to take sub-standard hearts and make them better."

"It is a very clever piece of kit with lots of clever chemicals and clever nutrients. It keeps the heart warm and measures the coronary flow and lots of other things. In this case we kept the heart on the rig for five hours just to show it worked, not to extend the time. Potentially using this kit we could store a heart for up to 12 hours. Without it, if you take a heart out of a body, it begins to rot after about four hours."

According to UK Transplant, 6,735 people are waiting for an organ transplant in the UK. Fewer than 3,000 are carried out and about 400 die waiting for a suitable organ. There are 104 people, including nine children, registered for a heart transplant in the UK and a further 43 waiting for a heart-lung transplant.

Last year, 146 people received a heart or heart-lung transplant, which is actually down from 170 the previous year. The number of heart transplants has been declining for a decade.

Professor Peter Weissberg, medical director of the British Heart Foundation, said: "This is a promising breakthrough for transplant surgery. For many very ill heart disease patients, transplant is still the best option. We hope this new technique will prove successful in more patients, so transplant teams can look further afield than they currently do for suitable hearts."

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