Filmed for first time: amazing transplant of a ‘warm, beating donor heart’
THE amazing moment a British transplant patient becomes one of the first to receive a ‘warm and beating’ donor heart has been c a pt ured for t he first time by television cameras.
The pioneering technique has the potential to transform the fortunes of hundreds of desperately ill transplant patients waiting for a lifesaving operation, say surgeons.
The procedure was filmed for a moving BBC documentary Heart Transplant: A Chance To Live, which marks the 50th anniversary of the UK’s first heart transplant.
In extraordinary footage, the donor heart can be seen in a clear box, still beating. State-of-the-art equipment in the box allows the heart to be kept in near-perfect functioning condition – with the donor’s own blood pumping through it – as it is taken by ambulance to the recipient.
Previously a donor heart had to be stopped before being transported ‘on ice’ in cold storage.
However, the longer the organ is outside a body and cut off from blood and oxygen, the less successful the transplant will be, limiting the distance it can travel.
Now, thanks to the ‘box’ – properly called the TransMedics Organ Care System – surgeons can keep donor hearts warm and beating for more than six hours outside the body, meaning organs can be transported across the country or internationally to reach a patient.
The number of patients awaiting lifesaving heart-transplant operations rose by 24 per cent last year, with experts declaring an organ shortage.
Both tissue and blood type need to match, and about 80 per cent of possible hearts are ultimately unsuitable because they are too diseased. Then there’s the added complication of geography: in cold storage a heart can survive for no more than four hours.
This ‘ischemic window’ means a race against time, hugely limiting the pool of available donors.
Now a handful of UK hospitals have used the new machine, which utilises a technique called ex-vivo perfusion that vastly extends the ischemic window.
In the documentary we meet Joy Thomas, a 54-year-old whose own heart is functioning at just 20 per cent after he contracted an auto-immune disease. In hospital for a year, he is barely able to walk.
He has been on the transplant waiting list at Newcastle’s Freeman Hospital for 297 days and his prospects look bleak.
Then doctors learn a donor heart has become available in Northern Ireland. Transported on ice, it would not have survived the journey – but a local charity agreed to pay the £40,000 cost of using the Organ Care System.
Accompanied by a skilled team of surgeons, nurses and other specialists, the heart is transported to Newcastle in the box, which has two parts; a portable platform and a perfusion chamber in which the organ sits.
The battery- powered platform houses wireless monitors that record vital information indicating the heart is healthy, and is fitted with an oxygen tank and pump to deliver a constant flow of warm blood – taken from the donor.
The transparent chamber maintains the sterile, humid and warm environment needed to keep the heart beating, and delivers a supply of nutrients.
By the time it arrives at the Freeman it has been outside the donor’s body for almost six hours.
Joy’s own diseased heart is removed while he is attached to a heart- bypass machine and the donor heart is stopped for a short time and drained of blood.
This allows surgeons to place it in Joy’s body and begin the painstaking process of connecting it to the blood vessels.
Ali Kindawi, a heart-transplant surgeon at the Freeman who operated on Joy, says: ‘Previously we would be very anxious about timing, because the conventional way of transferring a heart from the donor to recipient is in a box of ice and there is no time to lose before the cells of the heart are dying. With this machine you can be more relaxed. You can see if the heart is working nicely or struggling.’
Just 20 minutes after being sewn into Joy’s body, it begins to beat – and he is discharged from intensive care after five days. Then, 20 days after his transplant, the man who previously could not walk more than five steps is seen pedalling on an exercise bike.
Similar perfusion techniques have been used to extend the life of other donor organs, including the lungs and kidneys.
However, heart specialists are hailing the Organ Care System as the ‘ new frontier’ of transplant medicine.
With organs able to retain their functionality, it paves the way for perfusion ‘ hubs’ across Britain where organs can be repaired before being dispatched to hospitals around the country.
Andy Fisher, Professor of Respiratory Transplant Medicine at Newcastle University, is hugely optimistic about the possibilities offered by the TransMedics Organ Care System.
He says: ‘We can give different medications to the organ during perfusion. We could silence specific genes and give cell-based therapies. We believe we could be doubling or tripling the number of transplants that happen in the country. It’s a hugely exciting prospect.’
IT COULD HELP US TRIPLE THE NUMBER OF UK TRANSPLANTS