World-first technology pioneered by researchers at the Victor Chang Cardiac Research Institute and St Vincent’s Hospital, Sydney, is allowing surgeons to transplant donor hearts that have stopped beating after death – setting a new global precedent in organ transplant techniques and reducing wait times on heart transplant lists for patients.
Known as ‘Heart in a Box’ this novel technology has seen the number of successful transplants of hearts that have stopped beating after death (called DCD hearts) soar by a quarter at St Vincent’s Hospital, Sydney, since its introduction. New research revealing the technique has been published in the journal Transplantation.
A paradigm shift in organ donation
Before the first DCD heart transplant was performed in 2014, patients relied solely on donor hearts from brain-dead patients whose hearts were still beating at the time of retrieval.
Dr Yashutosh Joshi, St Vincent’s Hospital cardiothoracic registrar and lead author of the paper, said he expects the number of transplants to increase even further after research revealed survival outcomes were just as successful for those who received DCD hearts as those who received hearts from traditional brain-dead donors.
“Previously, donor hearts from a DCD pathway were not able to be used. In the last eight years we have now been able to retrieve these hearts and increase the donor pool which has had a positive impact on our waitlists with more heart transplants being performed than before,” explained Dr Joshi, who is also a recipient of a Heart Foundation PhD Scholarship.
Since 2014, 74 DCD transplants have been performed by the team at St Vincent’s.
How ‘Heart in a Box’ works
DCD transplants allow hearts to be donated from patients who have died after withdrawal of life support and in whom death is declared only after the heart has stopped beating. This is achieved by using a defined preservation fluid developed in the laboratory and a machine that allows the heart to beat outside the body which allows the organ to be reanimated and assessed.
Professor Peter Macdonald, from the Victor Chang Cardiac Research Institute and senior cardiologist at St Vincent’s Hospital, led the team that pioneered DCD heart transplant surgery.
“Since 2014 our team of scientists and surgeons have worked tirelessly to ensure outcomes are every bit as successful with this new technology. Now that this has been achieved and proved, we expect many more heart transplant teams around the world to embrace this technology,” he said.
“Around the world, there are now hundreds of people who have received DCD hearts. Our discovery has been life-changing and lifesaving for so many patients.”Professor Peter Macdonald
Initially, it was found that hearts retrieved from DCD donors took a lot longer to recover after transplantation. Around a third of patients had to be placed on a machine similar to heart-lung bypass for a short period of time to allow the newly transplanted heart to recover. However, the team from the Institute and the hospital has since worked out how to better protect DCD hearts during retrieval and transport, drastically reducing the need for this with only a small percentage now requiring temporary bypass.
Going forward, the team is now looking at ways to extend the period of time hearts can survive without circulation prior to transplantation.
Whilst the team at St Vincent’s Hospital in Sydney is the only one in Australia which can perform DCD transplants, its transplant team travels the country to retrieve suitable donor hearts by using the ‘Heart in a Box’ machine.
DCD Heart transplantation is now being carried out in the US, Spain, Belgium, the Netherlands, and the UK, where close to half of all transplants are now with DCD hearts.