New heart transplant method offers hope

WASHINGTON — Most transplanted hearts are from donors who are brain-dead, but new research shows a different approach can be just as successful and boost the number of available organs.

It is called donation after circulatory death, a method long used to recover kidneys and other organs but not more fragile hearts. Duke Health researchers said on Wednesday that using those long-shunned hearts could allow possibly thousands more patients a chance at a lifesaving transplant — expanding the number of donors' hearts by 30 percent.

"Honestly, if we could snap our fingers and just get people to use this, I think it probably would go up even more than that," said transplant surgeon Jacob Schroder from the Duke University School of Medicine, who led the research. "This really should be standard of care."

The usual method of organ donation occurs when doctors, through careful testing, determine whether someone has no brain function after a catastrophic injury — meaning they are brain-dead. The body is left on a ventilator that keeps the heart beating and organs oxygenated until they are recovered and put on ice.

In contrast, donation after circulatory death occurs when someone has a nonsurvivable brain injury, but because all brain function has not yet ceased, the family decides to withdraw life support and the heart stops. That means organs go without oxygen for a while before they can be recovered. And surgeons, worried the heart would be damaged, leave it behind.

But now, doctors can remove those hearts and put them in a machine that "reanimates" them, pumping through blood and nutrients as they are transported — and demonstrating if they work fine before the planned transplant.

The study, conducted at multiple hospitals around the country, involved 180 transplant recipients, half who received DCD, or donation after circulatory death, hearts and half given hearts from brain-dead donors that were transported on ice.

Survival six months later was about the same — 94 percent for recipients of cardiac-death donations and 90 percent for those who got the usual hearts, the researchers reported in the New England Journal of Medicine.

The findings are exciting and show "the potential to increase fairness and equity in heart transplantation, allowing more persons with heart failure to have access to this lifesaving therapy", transplant cardiologist Nancy Sweitzer from Washington University in St. Louis, who was not involved with the study, wrote in an accompanying editorial.

Agencies Via Xinhua