New methods could widen heart transplant pool
Two US hospitals have developed simpler ways to preserve hearts after circulatory death, potentially increasing access to life-saving transplants.
The approaches aim to overcome challenges with using hearts from donation after circulatory death (DCD) — where a patient’s heart stops after life support is withdrawn — as opposed to brain death, where the heart continues beating until organ removal.
Teams at Duke and Vanderbilt universities report successful transplants using new preservation strategies: Duke with a three-month-old infant, and Vanderbilt with three adult men.
Brendan Parent, director of transplant ethics and policy research at NYU Langone Health, described the studies as encouraging, though still at an early stage.
He said: “Innovation to find ways to recover organs successfully after circulatory death are essential for reducing the organ shortage.
“If alternatives pan out, I absolutely think that cardiac programmes will be thrilled, especially at hospitals that have rejected NRP.”
Most donor hearts come from people declared brain-dead and kept on ventilators until surgery.
But with circulatory death, the heart experiences a period without oxygen, which makes it more vulnerable to damage than some other organs.
Current DCD heart preservation includes a method known as normothermic regional perfusion (NRP), which involves restarting circulation by pumping oxygenated blood through the body after clamping off flow to the brain. Some hospitals avoid NRP due to ethical concerns.
Another option is to reanimate hearts in costly machines that pump blood and nutrients during transit. But according to Dr Joseph Turek of Duke, these machines are not designed for infant hearts — the group most in need.
Duke’s team introduced a middle ground: after practising on piglets, they removed the heart and connected it to oxygen and blood lines on a sterile operating table for a five-minute assessment — not in a machine, but in an operating room at another hospital.
The hospital, which did not permit the use of NRP, allowed Duke’s team to test their experimental method on a heart donated by a one-month-old whose family had agreed to donation.
The recipient was a three-month-old infant in urgent need.
Dr Turek said: “The coronary arteries are filling well, it’s pink, it’s beating.” The heart was then placed on ice and transported to Duke.
Vanderbilt’s technique involves flushing the heart with a cold, nutrient-rich preservative solution before removal — a process similar to that used with brain-dead donors.
Dr Aaron M. Williams, who led the Vanderbilt work, said: “That replenishes the nutrients that are depleted during the dying process and helps protect it for transport.”
He added that they have completed around 25 of these transplants.
“Our view is you don’t necessarily need to reanimate the heart,” Dr Williams said.
“These DCD hearts work just as well as hearts from brain-dead donors.”
Both techniques aim to address a persistent organ shortage.
Hundreds of thousands of adults have severe heart failure, and many are never offered transplants due to a lack of available organs.
Each year, about 700 children in the US are added to heart transplant waiting lists. Around 20 per cent die before receiving a donor heart, with infants particularly vulnerable, said Dr Turek.
In 2023, 43 per cent of deceased donors in the US died following circulatory death, yet only 793 of 4,572 heart transplants used DCD hearts.
