WASHINGTON – Most transplanted hearts come from brain-dead donors, but new research shows a different approach can be just as successful and increase the number of organs available.
It’s called “cardiac death donation,” a method that’s long been used to repair kidneys and other organs, but not more delicate hearts. Duke Health researchers said Wednesday that using these long-avoided hearts could potentially give thousands more patients a chance at life-saving transplants — which could increase the number of donor hearts by 30%.
“Honestly, if we could snap our fingers and get people to use this, I think it would probably go up even more,” said transplant surgeon Dr. Jacob Schroder of Duke University School of Medicine, who led the research. “It really should be the standard of care.”
The usual method of organ donation occurs when doctors, through careful testing, determine that someone has lost brain function after a devastating injury – meaning they are brain dead. The body is put on a ventilator, which maintains the heartbeat and oxygenation of the organs until they recover and are put on hold.
In contrast, a cardiac death donation occurs when someone has a non-survivable brain injury but the family decides to stop life support because all brain function has not yet stopped and the heart stops. That means organs are left without oxygen for a time before they can be restored – and surgeons, fearing the heart could be damaged, left it behind.
What’s changed: Doctors can now remove these hearts and put them in a machine that will “reanimate” them by pumping blood and nutrients through them during transport – and show that they are functioning properly before the planned transplant.
Wednesday’s study, conducted at multiple hospitals across the country, involved 180 transplant recipients, half of whom received DCD hearts and half received hearts from brain-dead donors transported on ice.
The survival rate six months later was about the same — 94% for those who received cardiac death donations and 90% for those who received the usual hearts, the researchers reported in the New England Journal of Medicine.
The results are exciting and show “the potential to increase fairness and equity in heart transplants and allow more people with heart failure access to this life-saving therapy,” said transplant cardiologist Dr. Nancy Switzer of Washington University in St. Louis, who “I am not affiliated with the study,” he wrote in an accompanying editorial.
Last year, 4,111 heart transplants were performed in the US, a record number but far from enough to meet demand. Hundreds of thousands of people suffer from advanced heart failure, but many are never offered a transplant and still others die waiting for a transplant.
Researchers in Australia and the UK first began doing DCD heart transplants about seven years ago. Duke pioneered the US experiments in late 2019, one of about 20 US hospitals now offering this method. According to the United Network for Organ Sharing, there were 345 such heart transplants in the US last year and 227 so far this year.
In the Duke-led study, nearly 90% of the reconstructed DCD hearts were transplanted, suggesting that more hospitals may be worth starting with the newer method.
Sweitzer noted that many potential donors have severe brain injuries but do not meet the criteria for brain death, meaning many potentially usable hearts are never donated. However, she also cautioned that there was more to learn, noting that the most severely ill patients on the waitlist in the study were less likely to receive DCD hearts.
Schroder said most who received DCD hearts already had heart pumps implanted, which made the transplant difficult to perform, even if they weren’t as high on the waiting list.
The study was funded by TransMedics, the manufacturer of the cardiac storage system.
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