Innovative Techniques Enhance Heart Transplant Availability for Patients

In a groundbreaking development, two major university hospitals in the United States have introduced innovative methods aimed at increasing the availability of lifesaving heart transplants for both adults and infants. These advancements come at a critical time when the shortage of transplantable organs has reached alarming levels, with many potential heart donations going unused due to existing recovery practices.

The research from Duke University and Vanderbilt University focuses on overcoming the barriers associated with utilizing organs from donors who experience circulatory death, commonly referred to as DCD (Donation After Circulatory Death). In a recent publication in the New England Journal of Medicine, surgeons from both institutions reported successful heart transplants using these new techniques. Dr. Aaron M. Williams, a lead author from Vanderbilt, emphasized, “These DCD hearts work just as well as hearts from brain-dead donors.”

Historically, most transplanted hearts have come from brain-dead donors, where the body is kept on a ventilator to maintain heart function until the organs are harvested. In contrast, DCD occurs when a patient with a severe brain injury has life support withdrawn and the heart ceases to function. The time frame between circulatory death and organ recovery presents challenges, particularly for hearts, which are more sensitive to oxygen deprivation compared to kidneys and other organs.

To address this issue, Dr. Joseph Turek from Duke University and his team have developed a methodology that combines efficiency and ethical considerations. Their approach involves temporarily attaching tubes of oxygen and blood to the heart on a sterile table in the operating room to assess its viability, rather than relying on complex machinery. This method was successfully tested on a 1-month-old infant donor whose heart was ultimately transplanted into a 3-month-old recipient at Duke. Turek noted, “It took just five minutes to tell that the heart was functional; it was pink and beating.”

Concurrently, Vanderbilt has implemented a simpler technique that involves infusing the heart with a nutrient-rich, cold preservative solution prior to removal, similar to the traditional handling of hearts from brain-dead donors. Dr. Williams detailed that this process replenishes nutrients depleted during the dying phase, enhancing the heart's viability for transport. To date, Vanderbilt has conducted approximately 25 successful transplants using this method.

The pressing need for more transplantable hearts is underscored by the statistics indicating that hundreds of thousands of adults suffer from advanced heart failure, with many never receiving the option of transplantation due to the organ shortage. In the U.S., approximately 700 children are added to the transplant list annually, with around 20% succumbing while waiting for a heart. In 2022, individuals whose deaths were classified as circulatory death represented 43% of the nation’s deceased organ donors, yet only 793 of the 4,572 heart transplants performed that year utilized these organs.

Given these figures, the exploration of new methodologies for organ recovery is deemed crucial. Brendan Parent, Director of Transplant Ethics and Policy Research at NYU Langone Health, stated that innovations in organ recovery techniques for DCD cases are essential for mitigating the organ shortage crisis. He indicated that if the alternative methods succeed, cardiac programs at various hospitals may eagerly adopt these practices, especially in facilities that have previously rejected the normothermic regional perfusion (NRP) recovery technique.

The advancements reported by Duke and Vanderbilt signify a pivotal moment in transplant medicine, promising to expand the pool of viable hearts and ultimately save more lives. As further research and clinical trials advance, the hope is that these innovative techniques will be adopted widely, addressing the urgent need for organ transplants in both adult and pediatric populations.

The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for the content.