New Approaches to Expanding Heart Transplants for All Ages

Two university hospitals are breaking new ground in their efforts to increase the availability of lifesaving heart transplants for both adults and infants.

This new study aims to tackle the challenges associated with using organs from individuals who have died after their hearts stop beating. Known as DCD, or donations after circulatory death, the approach often involves controversial techniques and costly equipment.

Surgeons from Duke and Vanderbilt Universities announced on Wednesday that they had developed a more straightforward method to retrieve these organs. In the New England Journal of Medicine, they shared details about successfully performing a heart transplant on a three-month-old infant at Duke, along with three adult males at Vanderbilt.

“These DCD hearts function just like those from brain-dead donors,” said Dr. Aaron M. Williams from Vanderbilt.

How to Prepare for a Heart Donation

Typically, most transplanted hearts come from brain-dead donors. In those cases, the body remains on a ventilator, keeping the heart beating until it can be harvested.

Circulatory death occurs when someone suffers a severe brain injury but has not entirely lost all brain function. In these instances, families may choose to withdraw life support, leading to the heart stopping. This can leave organs without oxygen for a period before retrieval, raising concerns about the heart’s viability, though kidneys and other organs might experience delays.

To check if a DCD organ is suitable, surgeons can circulate blood and oxygen to the abdominal and thoracic organs after gaining access to the brain. However, this approach is ethically contentious, and some hospitals have placed restrictions on the traditional perfusion methods known as NRP.

Another alternative involves “resuscitating” DCD organs using a machine that pumps blood and nutrients en route to the transplant facility. These machines are not only expensive but also quite complex. Dr. Joseph Turek from Duke mentioned that they are not suitable for very young children.

Innovative Methods for Heart Preservation

The team led by Turek found a middle ground. They proposed removing the heart, attaching a tube to supply oxygen and blood, and assessing its function on a sterile table in the operating room instead of relying on bulky machines.

During their trials, they practiced using piglets. The real test arrived when a nearby hospital was about to withdraw support for a patient whose family had expressed a wish to donate. While other facilities refrained from the controversial NRP techniques, Turek’s team had been experimenting with alternative methods.

In just five minutes, they noted, “The coronary artery is well filled, pink and throbbing.” They quickly placed the heart on ice for transportation to Duke.

Vanderbilt’s method is even simpler. Similarly to how hearts are treated from brain-dead donors, a cold preservative solution is injected before the heart is extracted, which “helps replenish nutrients that may have been depleted during the dying process,” Williams explained. Vanderbilt has conducted around 25 such transplants thus far, asserting that there’s no need to revive the heart.

The Need for More Donated Hearts

The demand for transplantable hearts is pressing. Hundreds of thousands of adults are living with chronic heart failure, and many aren’t offered transplants due to a lack of available organs.

Annually, approximately 700 children in the US are added to the transplant list for new hearts, with about 20% currently waiting. Turek highlighted that infants are particularly vulnerable in these situations.

Last year, circulatory deaths accounted for 43% of deceased donors in the country, leading to 793 out of 4,572 heart transplants.

Hence, numerous experts stress the critical importance of finding ways to utilize these hearts more effectively. According to Brendan’s parents at NYU Langone Health, who are involved in transplant ethics and policy research, while this new research is in its early stages, it holds promise.

“Innovations aimed at successfully recovering organs after circulatory death are vital for mitigating organ shortages,” he remarked.

If the alternative remains stagnant, “I think you would find that heart programs would eagerly embrace this, especially in hospitals that have avoided NRP,” he concluded.