The world’s first transplant of a “dead heart” has taken place in Australia, where doctors say that the surgical technique could significantly increase the number of potential donor organs.
The heart had stopped beating, and instead of being chilled after removal from the donor, it was revived and kept warm by a specialised procedure to keep it beating outside the body until the transplant operation.
Normally, hearts are kept beating inside the body of a brain-dead donor using life-support, but this puts a time limit on how long they can be kept as the organs can soon deteriorate, especially when they stop beating after they are removed.
Researchers at St Vincent’s Hospital in Sydney and the Victor Chang Cardiac Research Institute managed to revive hearts that had stopped beating for up to 20 minutes, in what they termed a "paradigm shift" in transplant procedures which could increase the pool of donor organs.
Donated hearts were kept beating in a machine for about four hours before transplantation and were monitored to assess whether they were suitable for the operation, said Professor Peter MacDonald, the leader of the surgical team.
“This is something that we have been researching really over the last four years, to sustain this period where the heart has stopped beating. Having done that we have developed a technique for then reactivating the heart,” Professor MacDonald said.
“We warm it up and the heart starts to beat. When it’s beating we can measure the metabolism of the heart and, based on the performance of the heart on the machine, we can tell quite reliably whether this heart will work,” he added.
When heart transplants first took place in the 1960s, it was routine to use “dead” hearts from patients after circulatory death, but this was only possible because donor and recipient were in adjacent operating theatres, said Kumud Dhital, from St Vincent’s Hospital
“This collocation of donor and recipient is extremely rare in the current era, leading us to rely solely on brain-dead donors – until now,” Dr Dhital said.
The new procedure involves a so-called “heart-in-a-box” machine where the organ is kept warm and beating outside the body, bathed in a special preservative solution rich in oxygen and nutrients.
“The incredible development of the preservation solution, with this technology of being able to preserve the heart, resuscitate it and to assess the function of the heart, has made this possible,” Dr Dhital said.
Between 2013 and 2014, there were 206 heart and heart-and-lung transplants in the UK but this new development could lead to more donor organs being available, said Professor Peter Weissberg, medical director of the British Heart Foundation.
“At the moment, hearts are chilled and are not beating when they are taken from the donor. This can cause them to deteriorate. The new technique could increase the number of potential donor hearts,” Professor Weissberg said.
Professor MacDonald explained that the work goes back 20 years. Three heart transplants have so far taken place using the technique and two of the three patients have recovered well – the third is intensive care because the transplant took place within the past week.
“We’ve been researching to see how long the heart can sustain this period in which it has stopped beating. We then developed a technique for reactivating the heart in a so-called heart-in-a-box machine,” Professor MacDonald said.
“To do that we removed blood from the donor to prime the machine and then we take the heart out, connect it to the machine, warm it up and then it starts to beat,” he said.
A 57-year-old Sydney woman Michelle Gribilas, and Sydney man Jan Damen, 40, were among the first patients to benefit from the procedure.
“I was very sick before I had it. Now I’m a different person altogether. I feel like I’m 40 years old. I’m very lucky,” said Ms Gribilas, who was suffering from congenital heart failure and had the surgery two months ago.