Duke Health researchers have found that reanimated hearts could potentially increase the number of donor organs by 30%. Heart transplants traditionally occur when doctors identify that the patient has no brain function after a catastrophic injury resulting in brain-death. The body is kept on a ventilator, which keeps the heart beating and organs oxygenated until they’re recovered. An alternative method is “donation after circulatory death,” which occurs when someone has a non-survivable brain injury but still has some brain function. The family chooses to withdraw life support, and the heart stops. This means the organs go without oxygen for a while before they can be recovered; hence, surgeons usually leave the heart behind, thinking it would be damaged.
However, Duke Health researchers have now discovered that these hearts can be reanimated –- pumped with nutrients and blood through a machine before being transported and checked for their reliability. Reanimated hearts were once shunned, but the study shows that they could potentially increase the availability of donor organs and save thousands of lives. If more hospitals used this alternative donation method, it could potentially save many more lives.
According to the 2023 research report in the New England Journal of Medicine, the study was conducted on 180 transplant recipients at multiple hospitals around the United States. Half of the patients received DCD hearts, and the other half received hearts from brain-dead donors that were transported on ice. The result showed that the survival rates for the patients were similar—94% for those who received a cardiac-death donation and 90% for those who got the usual hearts from brain-dead donors.
Dr. Nancy Sweitzer of Washington University in St. Louis, a transplant cardiologist, wrote in an accompanying editorial that the findings were “exciting” and could potentially increase fairness and equity in heart transplantation, allowing more people with heart failure to have access to lifesaving therapy. Last year, 4,111 heart transplants were performed in the US, which is a record-breaking figure, but it’s still not enough to meet the demand. Many people suffer from advanced heart failure, but they are never offered a transplant, and others die while waiting.
DCD hearts can provide a solution to this problem. Researchers in Australia and the UK were the first to try DCD heart transplants about seven years ago. Duke pioneered the U.S. experiments in late 2019 and are one of about 20 US hospitals currently using this method. Last year, there were 345 DCD heart transplants carried out in the US, and there have been 227 completed so far this year, according to the United Network for Organ Sharing. The study conducted by Duke, which showed that nearly 90% of the DCD hearts recovered during the trial were transplanted, suggests that it is worth conducting more such operations and using this method in more hospitals.
Dr. Jacob Schroder of Duke University School of Medicine, who led the research, is of the opinion that if the method could be used more widely, the increase in hearts available for transplant would be higher than the current 30%. In the study, most patients who received DCD hearts already had implanted heart pumps, making the transplant more challenging to perform, which is why they were not placed higher on the waiting list.
Although many would-be donors have severe brain injuries but don’t meet the criteria for brain death, which means that a lot of potentially usable hearts are wasted, more research needs to be done, as Sweitzer pointed out. She said that the very sickest patients on the waiting list were less likely to receive DCD hearts in the study.
TransMedics, which makes the heart storage system, funded the study. As the study found, the reanimation of hearts could increase the likelihood of a successful transplant, and the availability of donor organs, ultimately saving lives.
