For the first time in the US, doctors have brought an adult heart back to life and then transplanted it into another person who was in need of a new one. It is the first heart transplant to be carried out after a donor's heart has stopped beating, known as donation after cardiac death (DCD), rather than after a person has been diagnosed with brain death (DBD) but their heart is still beating, in the States.
The procedure has been carried out in both the UK and Australia, and doctors in the US are excited at the potential the new rules open up, decreasing organ waitlist times and saving lives.
The operation was conducted by surgeons at Duke University. Organ transplants are usually carried out after a patient has suffered irreversible brain death but machines can keep their heart and other vital organs alive. When a patient suffers cardiac arrest, however, the heart stops pumping blood around the body. Without oxygen-rich blood circulating, the cardiac cells begin to die and soon the whole organ becomes unusable for transplants.
The technique used to make the heart viable for transplantation is called warm perfusion. The organ is connected to a series of tubes and it is given blood, oxygen, and electrolytes at normal body temperature. The muscles in the organ begin to work again and with this approach, a heart can be kept viable for up to 10 hours.
Previous studies have shown that outcomes for patients receiving a DCD heart are similar to those who received a heart from a brain-dead donor.
The first-ever human heart transplant in 1967 was technically a DCD, but the donor and the receiver were next to each other. This modern approach was first carried out in 2015 by surgeons at the Royal Papworth Hospital, in Cambridge, UK.
"The @RoyalPapworth and St. Vincent’s (Sydney, AU) experiences have paved the way for our progress in the USA," Jacob Niall Schroder, the director of the heart transplant program at Duke University Medical Center tweeted. "[They] blazed the trail... with excellent results – decreased wait time and mortality and survival equivalent to DBD."
“This expands the donor pool (we expect up to as much as 30 percent) for those waiting for a new heart. If @RoyalPapworth's experience (approx 75 DCD heart transplants to date) has shown us anything, this will decrease waitlist time, deaths on the waitlist, with excellent survival results,” he added.