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HomeWeekly Roundup'Dead' heart transplant technique found suitable also for use with children

'Dead' heart transplant technique found suitable also for use with children

Doctors at the UK’s National Health Service (NHS) have pioneered the use of a “dead” heart transplant technique – previously deemed suitable only for adults – in children, saving the lives of six young patients last year. The Guardian reports that surgeons typically use for transplants hearts donated by patients who are declared brain stem dead but whose hearts are still beating. Retrieving the hearts of patients who have suffered cardiac death (which are far more common than brain stem deaths) is considered too risky a prospect.

Marius Berman, a consultant cardiothoracic transplant surgeon at Royal Papworth hospital (RPH) in Cambridge, said that after cardiac death the heart is “like an inflated balloon. So there is no way that we can assess if the heart is working well … that’s why it won’t be safe to retrieve the heart because we wouldn’t know how it functions.”

Previously, hearts were transported for intended recipients in sterile iceboxes. However, a “heart in a box” machine – called an Organ Care System (OCS), developed by the US company TransMedics – was engineered to emulate the human body, keeping the heart warm, beating and pumping blood so it is healthy for transport to the recipient.

The Guardian reports that the idea behind the machine was to allow for the organ to be transported across long distances.

In 2015 doctors at RPH pioneered the use of the machine to revive hearts from donors who had suffered cardiac death. By reanimating those hearts using the machine, doctors could assess whether the organ was salvageable for transplantation.

The concept worked, and since then, said Berman, “we have essentially doubled our heart transplant activity, every single year”. At some point the new method overtook the traditional way of organ donation after brain death, he added, while health outcomes for patients have remained constant.

Now, The Guardian reports, a collaboration between RPH, whose team retrieves the heart, and Great Ormond Street Hospital in London, whose team implants the organ, has pioneered the first use of the technique in paediatric transplantation.

Across the UK, the average wait for an adult who needs a heart transplant is nearly three years. Patients who need hearts typically exceed the number of available donor hearts, and children face even longer waiting times, given the right organ size must be found and the consent rate for child organ donation is relatively much lower.

Great Ormond Street has 24 children waiting for a heart transplant, and between 2014 and 2019 the average waiting time was 282 days.

“Transplant waiting times are significantly lower at RPH than the national average, not because we’re better surgeons,” said Berman. It was because the new approach saved time and money, he said.

The report says at the moment the technology is limited to donors who weigh at least 50kg, but the two hospitals are working on a new machine that will enable donation from even infants, which could usher in an era of transplantation for babies and young children where donors are the most scarce. A prototype is ready and the doctors expect to start using the machine by the end of this year.

 

[link url="https://www.theguardian.com/society/2021/feb/21/uk-doctors-pioneer-use-of-heart-in-a-box-transplant-technique-in-children"]Full report in The Guardian (Open access)[/link]

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