Medical milestone could increase hearts available for transplant

Using hearts after circulatory death could increase number of donors by 30 percent, says expert

ANN ARBOR, Mich. – About 3,500 people in the United States are waiting for a new heart.

Tragically, some will die before a heart becomes available.

Even more tragically, there are hearts available from would-be donors that are unable to be used. But new technology and research could help change that by dramatically increasing the number of hearts available for transplant.

Traditionally, hearts were only transplanted from donors who had been declared brain dead -- but still had a beating heart.

There are many more people who die in hospitals when their heart stops beating. For example, when someone has suffered injuries they can’t recover from and their family makes the decision to take them off life support.

This is called “circulatory death.” Even if this person wanted to be a donor, their heart couldn’t be used. But now, that’s changing.

In March, surgeons at the University of Michigan transplanted the health system’s first heart from a donor who had suffered a circulatory death.

It’s called DCD -- donation after circulatory death.

“Being able to use transplants from donors that pass from circulatory death could increase that number of donors by 30 percent. That’s a pretty substantial rise in organ donation,” said Dr. Jonathan Haft, the surgical director of heart transplant at U-M Health Frankel Cardiovascular Center.

Haft and cardiac transplant surgeon Dr. Ashraf Abou el ela a performed the landmark transplant.

The recipient was a man in his 30s who was born with a heart defect.

“He’s been suffering with heart failure for many, many years. He was an excellent candidate for transplant, but his condition was deteriorating,” explained Haft. “So we wanted the opportunity to be able to get him an organ within a reasonable timeframe.”

The use of hearts that have stopped beating for transplant is being made possible by a device called the TransMedics Organ Care System, or more simply the “Heart in a Box.”

Before its creation, all hearts were put on ice to be transported. But about 10 percent of the DCD hearts on ice wouldn’t work, so transplant surgeons didn’t want to take the risk of using them.

“Obviously, if you transplant somebody with a heart that doesn’t work, you may be worse off than the recipient was before you transplanted that heart, so you really need some type of assurance,” said Haft.

The “Heart in the Box” provides that assurance.

It circulates blood through the heart as it travels, allowing surgeons to essentially “test drive” the organ to make sure it wasn’t injured during the donor’s death.

It’s breath-taking, even for these veteran surgeons.

“We see those hearts functioning really well right away. I think it’s never going to get old to see a heart beating outside the body,” said Abou el ela. “We’re seeing life going into a heart that just died. So this is really a fascinating moment. It means a life opportunity for our patients.”

The “Heart in the Box” also expands where surgeons can go to pick up a heart. The previous time limit was four hours total from donor to recipient.

“If you’re on one side of the country, it becomes very challenging to accept the heart from the other side of the country,” said Haft.

The device has nearly doubled the amount of time the heart can safely spend outside the body.

Being able to accept donors whose heart has stopped beating also can provide comfort to donor families.

“Organ donation can be very meaningful for these families that have suffered tragedy,” said Haft. “Creating an opportunity where they now can donate these organs to people desperately in need can provide them some, some closure.”

“We’re very grateful to the donors and their families. Without organ donation, there is no transplantation,” said Abou el ela.

A gift of life that no one takes for granted.

“A lot of our patients come in end-stage heart failure, they are this close. And then, the fact that they can make it, and they go to sleep with a heart that’s barely functioning and wake up with a heart that has normal function is something that’s really, really gratifying for us,” said Abou el ela.

University of Michigan Health has now performed three of these heart transplants from donors who suffered a circulatory death. All of the recipients are doing well.

While this advance has the potential to increase the options for patients, it is still critical to increase the number of people willing to donate their organs. To learn more about organ donation or to join the Michigan Organ Donor Registry, click here.