DURHAM, NC – Most transplanted hearts come from brain-dead donors, but new research suggests another approach may be just as successful and increase the number of organs available.
It’s called circulatory death donation, a method long used to restore kidneys and other organs, but not the more fragile hearts. Using these long-shunned hearts could give thousands more patients a chance at a life-saving transplant — increasing the number of donor hearts by 30%, Duke Health researchers said Wednesday.
“Honestly, if we could snap our fingers and just get people to use it, I think it would probably grow even more than that,” said transplant surgeon Dr. Jacob Schroeder of Duke University School of Medicine, who led research. “That really should be the standard of care.”
A common method of organ donation is when doctors determine through careful testing that someone’s brain is not functioning after a catastrophic injury – meaning they are brain dead. The body is left on a ventilator, which keeps the heart beating and oxygenating the organs until they are recovered and placed on ice.
In contrast, donation after circulatory death occurs when someone has a non-survivable brain injury, but because all brain function has not yet stopped, the family decides to stop life support and the heart stops. This means organs are deprived of oxygen for some time before they can be repaired – and surgeons, fearing the heart could be damaged, left it alone.
What’s changed: Doctors can now remove those hearts and place them in a machine that “resuscitates” them by pumping blood and nutrients while they’re being transported — and demonstrating whether they’re working well before a scheduled transplant.
The study, conducted Wednesday at several hospitals across the country, involved 180 recipients, half of whom received DCD hearts and half of whom received hearts from brain-dead donors transported on ice.
Survival after six months was about the same — 94% for recipients of heart-death donations and 90% for those who received a normal heart, the researchers reported in the New England Journal of Medicine.
The findings are exciting and show “the potential to increase equity and equity in heart transplants by allowing more people with heart failure to have access to this life-saving therapy,” said transplant cardiologist Dr. Nancy Schweitzer of Washington University in St. Louis, who was involved in the research, wrote in an accompanying editorial.
A record 4,111 heart transplants were performed in the U.S. last year, but far from enough to meet the need. Hundreds of thousands of people suffer from advanced heart failure, but many are never offered a transplant, and others die waiting for one.
Researchers in Australia and Great Britain first began trying DCD heart transplants about seven years ago. At the end of 2019, Duke was the initiator of the American experiments, one of about 20 American hospitals that now offer this method. Last year, 345 such heart transplants were performed in the United States, and 227 this year, according to the United Network for Organ Sharing.
In the Duke-led study, nearly 90% of healed DCD hearts were transplanted, suggesting that more hospitals should use the new method.
Switzer noted that many potential donors have severe brain injuries but do not meet the criteria for brain death, meaning that many potentially suitable hearts will never be donated. But she also cautioned that there is more to learn, noting that the sickest patients on the waiting list were less likely to receive a DCD heart in the study.
Schroeder said most of those who received DCD hearts already had heart pumps implanted, making it difficult to get a transplant, even if they weren’t high on the waiting list.
The study was funded by TransMedics, which makes the heart storage system.
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