New heart transplant method could allow more patients to undergo life-saving surgery

WASHINGTON (AP) — Most transplanted hearts come from brain-dead donors, but new research shows a different approach can be just as effective and increase the number of organs available.

This is called circulatory donation after death, a method long used to salvage kidneys and other organs but not more fragile hearts. Duke Health researchers said Wednesday that using these long-avoided hearts could allow thousands more patients to benefit from life-saving transplants, increasing the number of donor hearts by 30%.

“Honestly, if we could snap our fingers and get people to use it, I think it would probably increase even more than that,” said transplant surgeon Dr. Jacob Schroder of Duke University School of Medicine, who has directed the research. “That really should be the standard of care.”

The usual method of organ donation occurs when doctors, through careful testing, determine that a person has no brain function after a catastrophic injury, meaning they are brain dead. The body is left on a ventilator which keeps the heart beating and the organs oxygenated until they are retrieved and placed on ice.

In contrast, donation after circulatory death occurs when a person has an unsurvivable brain injury but because all brain function has not yet ceased, the family decides to remove the life support system and the heart stops. This means the organs are starved of oxygen for a period of time before they can be recovered – and surgeons, fearing the heart could be damaged, left it behind.

What’s changed: Now doctors can remove those hearts and put them in a machine that “resuscitates” them, pumping out blood and nutrients during transport — and demonstrating whether they’re working properly before the planned transplant.

Wednesday’s study, conducted at multiple hospitals across the country, involved 180 transplant recipients, with half receiving DCD hearts and the other half hearts from brain-dead donors that were transported on ice. .

Survival six months later was about the same – 94% for recipients of cardiac death donations and 90% for those who received the usual hearts, the researchers reported in the New England Journal of Medicine.

The results are exciting and show “the potential to increase justice and equity in heart transplantation, allowing more people with heart failure to have access to this lifesaving therapy,” said the transplant cardiologist, Dr. Nancy Sweitzer of Washington University in St. Louis, who was not involved in the study, wrote in an accompanying editorial.

Last year, 4,111 heart transplants were performed in the United States, a record number but far from enough to meet the need. Hundreds of thousands of people suffer from advanced heart failure, but many are never offered a transplant and still others die while waiting for a transplant.

Researchers in Australia and the UK started trying DCD heart transplants about seven years ago. Duke pioneered US experiments in late 2019, one of about 20 US hospitals now offering the method. Last year, there were 345 such heart transplants in the United States, and 227 so far this year, according to the United Network for Organ Sharing.

In the Duke-led study, nearly 90% of recovered DCD hearts were transplanted, signaling that more hospitals are worth starting to use the new method.

Sweitzer noted that many potential donors suffer severe brain damage but do not meet the criteria for brain death, meaning many potentially usable hearts are never donated. But she also warned there was still a lot to learn, noting that the sickest patients on the waiting list were less likely to receive DCD hearts in the study.

Schroder said most of those who received DCD hearts already had heart pumps implanted which made the transplant harder to complete, even if they weren’t ranked as high on the waiting list.

The study was funded by TransMedics, which manufactures the cardiac storage system.

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The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute Science and Education Media Group. The AP is solely responsible for all content.

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