UK doctors first to perform ‘heart in a box’ transplants
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NHS doctors have become the first to give children donor hearts revived by machine and kept ‘alive’ for hours during delivery to the patient.
Staff at Great Ormond Street Hospital (GOSH) and Royal Papworth Hospital (RPH) in London and Cambridge respectively collaborated on the medical breakthrough which saved the lives of six children last year.
The “game-changing” technique, known as donation after circulatory death (DCD), sees hearts being reanimated and kept beating outside a human body until they are ready for transplanting.
Historically, donor hearts have been taken from people who are brain dead but whose hearts are still beating. This limits the number of transplants possible.
The machine used for DCD perfuses the heart with warm blood after surgeons remove it from the donor, keeping it functional and “alive” enough for transportation and transplantation several hours after retrieval. It also allows surgeons to assess the heart’s functionality in a way that wasn’t previously possible.
The collaboration between RPH (whose team retrieves the heart), GOSH (whose team implants the organ), and NHS Blood & Transplant represents the first use of the DCD technique in paediatric transplantation anywhere in the world, the team said.
Jacob Simmonds, consultant cardiologist and transplant physician at GOSH, hailed the significance of the programme.
“In early 2020 we had more children at GOSH on the transplant list than I’d ever seen in my 16 years working at the hospital,” he explained. “Every day a child waits there is a bigger likelihood that they may get too ill even for transplantation, or worse.”
He added: “Although medical advances have come far, for some children with heart failure an organ donation is truly their only hope.”
The DCD heart programme has unlocked more opportunities for donation, essentially doubling the number of transplants done at GOSH in eligible patients weighing more than 20kg, he said.
“It’s game-changing and work is already underway to make the technique suitable for our much younger and smaller patients,” he added. “Ultimately, though, this still relies on families having conversations around their organ donation wishes, and then, of course, the bravery to consider making this precious, life-saving gift at a time of unimaginable tragedy.”
The first patient to receive a DCD heart under the collaboration was 15-year-old Anna Hadley, who received a diagnosis of restrictive cardiomyopathy after collapsing during a PE class two months earlier. The rare condition meant that the muscles in the lower chambers of her heart (the ventricles) were becoming stiff and could not fill with blood properly, affecting blood flow to the rest of her heart and body.
After an assessment at GOSH, the family was told that Anna’s best chance of recovery was a heart transplant.
There is a shortage of suitable donors in the UK, so the number of children who would benefit from organ transplantation exceeds the number of organs available. Children also face longer-than-average waiting times because of the difficulty of finding the right match and because the consent rate for paediatric organ donation is much lower than the national average for adults.
“No-one else in the world is currently doing this,” said Marius Berman, a consultant cardiothoracic transplant surgeon at RPH. “It’s been an incredible multi-institutional and multidisciplinary team effort to make this possible, involving everyone from the specialist nurses in organ donation and retrieval, transplant coordinators, physicians, and surgeons.”
“Above all, none of this would be possible without the generosity of every donor and their families.”
Last year, researchers at MIT developed a bionic ‘heart’ – a hybrid made of heart tissue and a robotic pumping system – that offers a more realistic model for testing out artificial valves and other cardiac devices.
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