New heart transplant breakthrough could give more patients the chance to have life-saving surgery: Duke University researchers

Durham, North Carolina — Most transplanted hearts come from brain-dead donors, but new research shows that another approach could be equally successful, increasing the number of available organs.

This is called circulatory postmortem donation and has been used for years to restore kidneys and other organs, but not the fragile heart. Duke Health researchers Wednesday said using the long-shunned heart could potentially give thousands more patients a chance at life-saving transplants, boosting the number of donor hearts by 30%. announced.

“Honestly, if we can snap our fingers and get people to use this, it’s probably more than that,” said Dr. Jacob Schroeder, a transplant surgeon at Duke University School of Medicine, who led the study. “This really should be the standard of care.”

The usual method of organ donation is when a doctor determines through careful examination that the brain has no function after a fatal injury, or is brain dead. The corpse remains on a ventilator that keeps the heart beating and the organs oxygenated until it recovers and is placed on ice.

In contrast, post-circulatory death donation is when someone sustains a non-viable brain injury, but because all brain function has not yet ceased, the family decides to discontinue life support, and the heart fails. done if it stops. This meant that the organs would be starved of oxygen for some time while they recovered, and the surgeons feared the heart would be damaged and left it alone.

What’s changed: Doctors now take these hearts out and put them into machines that “resuscitate” them, pumping them with blood and nutrients during transport and determining whether the hearts are functioning properly before a scheduled transplant. have been able to prove it.

Wednesday’s study, conducted at multiple hospitals across the country, involved 180 transplant recipients, half of whom received DCD hearts and the other half from brain-dead donors shipped on ice.

Six-month survival rates were similar, with a 94% survival rate for those receiving cardiac death donations and a 90% survival rate for those receiving normal heart donations, researchers said in New England. Reported to the Journal of Medicine.

The results of the study are exciting and show that “heart transplantation has the potential to become more equitable and equitable, allowing more heart failure patients to receive this life-saving treatment,” St. Louis said. said Dr. Nancy Switzer, a transplant cardiologist at the University of Washington. She was not involved in the study, she wrote in an accompanying editorial.

There were 4,111 heart transplants performed in the United States last year, a record number but not enough to meet the need. Hundreds of thousands of people suffer from progressive heart failure, many of whom do not receive transplants, and some die while waiting for transplants.

Researchers in Australia and the UK first began trying DCD heart transplants about seven years ago. Duke pioneered the trial in the United States at the end of 2019 and is now one of about 20 US hospitals offering the method. There were 345 such heart transplants in the United States last year, and 227 so far this year, according to the Organ Sharing Network.

Nearly 90% of recovered DCD hearts will be transplanted, according to a study led by Dr. Duke, showing that more hospitals deserve to start using the new method.

Sweitzer said many would-be donors have severe brain damage but do not meet the criteria for brain death, meaning many potentially usable hearts are not donated. But she also noted that critically ill patients on the waiting list were unlikely to receive DCD hearts in the study, and cautioned that there is still much to learn.

Schroeder said most people who get DCD hearts already have heart pumps, which makes the transplant more difficult, even if they aren’t high on the waiting list.

The study was funded by Transmedics, which manufactures heart preservation systems.

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