Are nonbeating heart transplants on the horizon?
Tuesday, September 26, 2017
A donation after cardiac death (DCD) pilot program being carried out in three British hospitals could decrease heart donation waiting lists by as much as 40 percent, officials say.
A nonbeating heart is restored with energy from a "beating machine" as it is transported from the deceased donor to the recipient. Results are comparable, if not better, than transplants from brain-dead donors, the type of donors that have been used for heart donations for decades.
After the heart is removed from a person who has had ended life support, function to the heart is restored using the TransMedics Organ Care System, which pumps blood through the arteries. The heart is now ready for transplantation to a living person.
DCD was used until the 1970s when brain death criteria became established. After those criteria were set, only brain-dead patients could be used as heart donors since their hearts were still beating. The organ care system allows transplants to occur even after a donor has died and blood stopped flowing through the heart.
Simon Messer, cardiothoracic transplant registrar at Papworth Hospital who helped pioneer the project, told The Independent this team was "delighted" with the results seen at the pilot sites. Some 30 DCD transplants have been carried out at Papworth since the program began.
"Previously, we couldn’t use these hearts for transplantations because the heart has stopped beating, but this procedure sees the organ restart using a beating machine, which restores the energy supply during the journey from the donor hospital to the recipient hospital," he said. "We're delighted. It's a phenomenal program and such a fantastic operation, because you've got people with complete, end-stage heart failure, and it can bring them back to their normal form."
Indeed, patients who received a heart transplant as part of a DCD operation experienced a 90-93 percent survival to discharge rate.
Britain and Australia are the only countries in the world where DCD organ donations are performed. The first such surgery was performed in Australia in 2014; DCD organ transplants have been done in Britain since 2015.
Messer said surgeons from other Europeans countries have consulted the pilot sites for guidance.
"The rest of the world is interested because they've seen our results, and the patients with us who have survived," Messer said. "Doctors from the Netherlands, France, Spain, Canada and others have been here to see how it’s done and learn the techniques. But none of them have rolled it out yet."
The outcome of the DCD pilot program is welcomed in Britain where 450 people died in 2016 while waiting on a new heart. The number of donors who register to participate in traditional brain-death donations has plateaued in recent years.
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