by Matt Batcheldor
In the first such procedures in Tennessee, Vanderbilt University Medical Center has successfully used technology to bring two donor hearts that stopped beating back to life before transplanting them into patients.
Until recently, such hearts, categorized as donation after cardiac death (DCD), could not be used for transplant and were discarded.
VUMC’s Cardiac Surgery team used a warm blood perfusion system to reanimate the hearts before transplanting them into patients over the last month, joining only a handful of such transplants performed nationwide. VUMC is among five centers participating in a recently launched clinical trial to transplant the DCD hearts.
Using DCD hearts has the potential to greatly expand the number of hearts available, providing more life-saving transplants for VUMC patients and shortening wait times for people badly in need of a transplant. The risk of dying on the waiting list is at least 10% and death rates increase the longer a patient has to wait.
“It is a new frontier in heart transplantation,” said Ashish Shah, MD, professor and chair of Cardiac Surgery. “Although this has been done for other organs like lung, liver and kidney, it has really never been done before in the United States on hearts in this manner until very recently. The idea of machine perfusion really is groundbreaking and could potentially change the field in several ways.”
In addition to expanding the donor organ pool, Shah said the DCD transplants will help doctors gain a better understanding about how hearts work when injured and how they can be restored. “How do you repair hearts so that we don’t need transplant?” he said.
DCD heart transplants are very different than conventional procedures. In a traditional heart transplant, a brain-dead donor is brought to the operating room in a well-planned process. Doctors infuse a preservation solution into the heart and other organs before it is removed, placed on ice and delivered it for transplant. Such a process takes 20 to 30 minutes, plus what can be hours of travel time before the heart can reach its destination.
A DCD transplant is far more complex, Shah said. In a DCD transplant, donors are not officially brain dead, so they are taken to the operating room where the heart naturally stops. Once the patient is declared dead, surgeons race to open the chest, insert tubes to infuse the preservation solution and then remove the heart— all within 20 minutes. From there the team re-animates the heart on the perfusion system to determine if it is usable.
“It can take several hours and a fair amount of delicate manipulation, but ultimately we believe these will be healthy hearts that can save someone’s life,” Shah said.
Vanderbilt’s surgical teams for the first DCD heart transplants included surgeons Shah, Keki Balsara, MD, and William McMaster, MD; and perfusionists Matthew Warhoover, MS, CCP, LCP, and Harry Moneypenny, BS, CCP, LCP.
No other transplant center in the nation transplants more hearts than VUMC, which performed a record 118 transplants last year.
The Vanderbilt Transplant Center is the South’s premier transplant center, providing more opportunity for patients to participate in clinical trials that help advance the science of organ transplantation, as well as access to other specialists. Its transplant teams have performed more than 9,500 solid organ transplants since 1962, including all major organs — heart, kidney, lung, liver and pancreas.