A method to “resuscitate” the hearts of organ donors works as well as the standard method of harvesting hearts for transplants, new research suggests. If widely adopted, this method could increase the number of heart donors by around 30%.
“Honestly, if we could snap our fingers and just get people to use it, I think it would probably increase even more.” Doctor Jakūb ShroderThe transplant surgeon at Duke University School of Medicine, who led the study, told The Associated Press. “It really should be a standard of care.”
Most transplanted hearts are from brain-dead donors who died due to complete loss of brain function rather than circulatory death due to cardiac arrest. A patient with brain disease can be declared dead before their heart stops beating, which allows doctors to remove the heart while it is still perfused with oxygenated blood, so it is not damaged by a lack of oxygen. The heart is then washed with a preservation solution, placed in a cooler filled with ice, and rushed to the recipient.
In the latest test results released on Thursday (June 8),. The New England Journal of Medicine doctors compared the survival rates of transplant recipients who received hearts from brain-dead donors with those who received hearts from donors who died of circulatory death. A total of 166 heart transplant patients living in the US were included in the primary analysis, with 86 in the brain death group and 80 in the circulatory group.
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Six months after surgery, the brain-dead group had a 90% survival rate and the circulatory group had a 94% survival rate, suggesting that donation after circulatory death, or DCD, is an equally promising method of heart transplantation.
DCD is made possible by “extracorporeal machine perfusion,” which involves connecting the donor organ to a machine that pumps blood and nutrients through its tissues. The new study tested a perfusion system called the Organ Care System Heart, made by the study’s funder, TransMedics. The system warms the blood that is pumped through the donors’ hearts, compared to other perfusion systems that still need to cool the organ in order to preserve the organ.
Although both groups had similar survival at six months compared with the traditional heart transplant group, moderate and severe DCD were slightly higher in the DCD group. primary graft dysfunction, when one or both ventricles of the heart show dangerous dysfunction within 24 hours of transplant surgery. However, none of the DCD patients had primary graft failure that required retransplantation, whereas two people in the conventional transplant group did.
Overall, the incidence of serious adverse events was very low and similar in both groups at 30 days postoperatively.
The new study involved multiple medical centers and built on previous evidence in favor of DCD, which was largely based on single case studies and small studies conducted at single centers in Australia and the United Kingdom, the study authors wrote.
However, historically, one major barrier to using perfusion systems for hearts and other donated organs has been cost. Still in 2019, Dr. Brian Lima, director of heart transplantation at Sandra Atlas Bass Heart Hospital in Manhasset, New York, told Live Science that several studies have compared perfusion with standard refrigeration; therefore, there was no “earth-shattering data” to convince hospitals to make the costly switch across the country.
But at the time, doctors at Duke University Medical Center had just performed the first-ever adult heart transplantation with a “reanimated” organ. Following this important procedure, Lima suggested that perfusion could soon become the standard of care.