A trio of breakthrough heart transplants made history in October as surgeons in Australia transplanted "dead" hearts into three patients. Two of the three patients are recovering nicely, the third had more recent heart transplant surgery and is recovering in the intensive care unit.
The initial success for all three surgeries was credited to the perfusion-based machine that is able to sustain dead hearts. Hearts from cadavers that had not beaten for up to 20 minutes were reanimated and transplanted into waiting patients. Actually, these hearts were not dead, they were in a state that closely resembles suspended animation where the heart is preserved until it is reanimated.
The research team at St. Vincent's Hospital in Sydney believes that this new technique has the potential to save 20 to 30 percent more heart transfer patients as it widens the pool of available hearts.
The technique
Dead hearts are revised using a perfusion-type machine. After resuscitation, the nonbeating heart is placed in the machine — a box that supplies the heart with oxygen. Doctors call the machine "heart in a box," but its actual name is OCS Heart by TransMedics, a company based in Andover, Massachusetts.
The heart is revived using the portable OCS Heart by warming it and perfusing it with oxygenated and nutrient-rich blood. Perfusion has been in use for a long time. For example, EMTs responding to an ambulance call check the patient's perfusion by timing how fast the capillaries in under your skin refill with blood.
After the heart begins running properly in the box, doctors retrieve the heart from the box and inject it with a preservation solution. The solution keeps the heart fresh as it becomes accustomed to its new home. It also keeps the heart healthy enough to undergo surgery.
The console and box development took place at TransMedics, while the preservation solution was developed by the Victor Chang Institute.
"So those two things coming together [the console and preservation solution] almost like a perfect storm, have allowed this sort of transplantation of a heart that's stopped beating to occur," Professor Bob Graham, the executive director of the Victor Chang Institute, told reporters. "Before that, it wasn't possible.
How patients feel
Michelle Griblis is a 57-year-old woman who was the first patient to undergo this advanced procedure. Before the transplant surgery she was bed-ridden, but now says, "I feel like I'm 40 years old."
Jan Damen is the father of three and age 44. Keeping us with his rambunctious family was difficult if not impossible. Now that difficulty is fading. "I feel amazing," he told The Sydney Morning Herald. "I have to say I never thought I'd feel so privileged to wear the St Vincent's pajamas."
The outcome of the third patient is too early to tell as the patient is still recuperating from surgery.
Other uses of perfusion technology
Perfusion technology has been proven in lung transplants using the solution, and the TransMedics OCS Lung. A unit that is based on the breakthrough technology of the OCS Heart. In one case, the OCS Lung kept a kidney alive for 11 hours outside of a human body.
Presently, "dead heart" transplant surgery and lung surgery is only available in Australia and Europe, but researchers disclose that it is under investigation in the United States.
According to the Victor Chang Institute, the breakthrough shows "a paradigm shift in organ donation" with the potential to "result in a major increase in the pool of hearts available for transplantation."
