On a given day, up to 114,000 people await a transplant in the United States, and the heart is one of most in-demand organs. On Sunday, a heart transplant team at Duke University became the first in the U.S. to bring a heart from a deceased donor back to life—and transplant it into a living recipient. In a process called donation after circulatory death (DCD heart warm perfusion), an artificial circulatory machine pumps warm, oxygenated blood through the heart once removed from the donor, effectively reviving the organ. This process gives surgeons up to 12 hours to transport the organ to the recipient—a notable increase from the current 4- to 6-hour window of viability for a heart.
“This surgery marks the first time in the U.S. that a heart utilized for transplantation was derived from a non-brain dead donor,” explains Brian Lima, MD, a cardiothoracic surgeon at Northwell Health via email. “Until recently, hearts could never be used in these instances because waiting until ‘cardiac death’ could damage the viability of the heart. But thanks to the advent of ex-vivo heart perfusion (so-called heart-in-a-box) technology, that heart could be resuscitated on a perfusion apparatus and assessed for viability.”
On average, 20 people die every day waiting for organs in the United States, according to the American Transplant Foundation. Duke is currently one of just five medical centers in the United States carrying out DCD heart transplantation in clinical trials, but Dr. Lima says widespread adaptation of the practice could broaden the donor pool by as much as 30 percent.
“Specifically, it may nearly double the number of heart transplants performed, which is what has born out abroad.” —Brian Lima, MD, a cardiothoracic surgeon at Northwell Health
Implementation DCD for heart transplants in England and Australia increased the volume of available hearts for transplant by 40 percent, according to Dr. Lima. “This has the potential for substantially expanding the donor pool for heart transplantation and prevent the thousands of heart failure deaths that occur every year due to the organ shortage crisis,” he says. “Specifically, it may nearly double the number of heart transplants performed, which is what has born out abroad.”
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