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Four heart transplants performed in whirlwind 48 hours

Aug. 26, 2020, 2:27 PM

Members of the heart transplant perfusion and recovery team pose with the TransMedics system used to preserve organs during transport. From left are Ashish Shah, MD, Harry Moneypenny, CCP, LCP, Matthew Warhoover, MS, CCP, LCP, Jordan Hoffman, MD, Kyle Rider, CCP, Joey Lepore, RN, CCP, LCP, and Marina Mailyan, MS, CCP, LCP.
The Vanderbilt Heart Transplant perfusion and recovery team poses for a photo with the device used to transport hearts across the country in the atrium of the Critical Care Tower in Vanderbilt University Medical Center Adult Hospital on Wednesday, August 26, 2020 in Nashville, Tennessee.

by Matt Batcheldor

The Vanderbilt Transplant Center’s cardiac surgeons transplanted four hearts in one 48-hour stretch in August, thanks to VUMC’s perfusion and organ recovery teams traveling more than 4,000 miles across the country to obtain the donor organs.

“It was quite an amazing feat,” said Jordan Hoffman, MD, assistant professor of Cardiac Surgery. “Many transplant centers don’t have the ability to do something like this. There are very few in the country and around the world that can — maybe fewer than two to three centers.”

Hoffman said the accomplishment reflects the work of the entire transplant team, including the coordinators who identify matching organs, the transplant committee that decides which patients get them, the recovery teams that pick them up and the surgeons who retrieve and implant them.

It also reflects VUMC’s cutting edge technologies. Donor organs can be preserved longer after retrieval with the TransMedics Organ Care System, which allows hearts to continue beating outside the body. VUMC is one of a select few centers nationwide using it in a clinical trial.

The TransMedics system, affectionately known as “Heart in a Box,” can be used to preserve organs instead of the conventional method of putting donor organs on ice, particularly when organs must travel hours to VUMC. On ice, organs begin to deteriorate after about three hours and outcomes become progressively worse.

“We can, and have, traveled to any part of North America to get great hearts to critically ill patients and save lives,” Hoffman said.

In addition, two of the four organs transplanted in those 48 hours were DCD, or Donation after Circulatory Death, which many centers are unable to use. The organs are recovered after a patient has died, rather than the conventional method of obtaining them from a living but brain-dead patient.

The deceased person’s organs are preserved using a new warm perfusion system. VUMC became the first center in Tennessee to successfully rehabilitate a DCD heart in February, joining just a handful of centers that had completed such transplants.

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.

Vanderbilt Transplant Center is the No. 1 heart transplant program by volume in the United States, performing a record 118 heart transplants in 2019. While other centers have reduced the pace of heart transplants during the COVID-19 pandemic, VUMC has not slowed down, Hoffman said.

Having a large transplant team makes it possible to deploy multiple organ recovery groups simultaneously to retrieve organs, Hoffman said.

As many as five people travel to obtain one organ — a surgeon and trainee surgeon, two perfusionists and a preservationist. Using the TransMedics device, VUMC draws from a smaller pool of specialized perfusionists, said Matthew Warhoover, MS, CCP, LCP, associate chief perfusionist.

He said his team of 11 perfusionists typically gets six to eight hours of notice that they will have to travel to get an organ.

“Everybody steps up and does their part, whether it’s in a supportive role of backfilling a hole that’s been left so somebody can leave or it’s somebody coming from home that wasn’t scheduled to be in that day,” he said. “It is rewarding because there is no better feeling than giving someone a new chance at life.”

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