'Heart-in-a-box' technology lets Canadian organ donor save a life

Lorraine Sherren says what's holding her togeth‐ er as she and her husband grieve the death of their 40-year-old son is knowing he was able to donate his heart, with some out-ofthe-box thinking.

Robbie Sherren was a Special Olympics bowler, Trekkie and computer whiz, his parents said. What started as a trip to the emer‐ gency department for seemingly just a sprained an‐ kle wound up with him no longer breathing, experienc‐ ing an aneurysm and almost 100 tiny strokes.

His mother was devas‐ tated when doctors initially told her Robbie wouldn't be able to donate his heart be‐ cause she knew how much it would've meant to him. He had been donating blood for decades.

"He was just a special man with an infectious smile," she said.

"Everybody liked him, he never got into any trouble," his father, Derk Sherren, said of their red-headed son who chose to live at home.

Normally, hearts can only be donated in Canada after brain or neurological death, where the heart continues to beat after the patient is de‐ clared deceased.

But within hours of that initial "no," while Robbie was still on life support, the Kingston chapter of Trillium, Ontario's organ and tissue donation agency, stepped in with an idea: After the heart stopped beating, remove it, give it blood and use a speci‐ al resuscitation box to keep it warm, beating and viable with oxygen and nutrients while en route to the recipi‐ ent.

While the technology ex‐ ists, Canadian hospitals don't have it. The Kingston hospital contacted a U.S. team of sur‐ geons to bring their equip‐ ment north for the surgery.

When Robbie died on May 7, he became the first Cana‐ dian adult to donate his heart after cardiac or circula‐ tory death (DCD), according to Kingston Health Sciences Centre.

Robbie's heart went to an

American recipient.

"It is what is holding us to‐ gether and helping us to cope with loss," his mother said of the donation.

Dr. Gordon Boyd, a critical care physician and neurolo‐ gist at the Kingston hospital, treated Robbie and applauds the patient and his parents for the legacy he's left.

"He died in ICU with family by his side," Boyd said, choking back tears as he re‐ called the parents telling Robbie to let go.

Boyd said doctors follow strict criteria for donation af‐ ter brain death, which in‐ cludes confirming the pupil is fixed and dilated in response to shining a light into the eye. Boyd said since Robbie's pupil movement was inter‐ mittent, he didn't qualify, al‐ though he wouldn't ever be able to recover from the brain injury.

The parents decided to stop life-sustaining thera‐ pies.The hospital said typical‐ ly when people suffer a car‐ diac death, the heart experi‐ ences too much tissue dam‐ age after it stops beating, due to lack of oxygen, mak‐ ing it unsuitable for dona‐ tion.

TransMedics's heart-in-abox technology changes that by keeping the heart pump‐ ing and oxygenated, extend‐ ing the length of time be‐ tween organ retrieval and transplantation.

Boyd said Robbie "sparked a flame" that could mean DCD will eventually be‐ come routine in Canada.

Heart transplants could increase nearly 30%

Dr. Vivek Rao, surgical di‐ rector of the cardiac trans‐ plant program at the Peter Munk Cardiac Centre in Toronto, said the first human heart transplant in 1967 by Dr. Christiaan Barnard was also a DCD.

The approach was aban‐ doned for 40 years until the advent of heart-in-a-box technology, which is now used in parts of Europe and the U.S.

In 2023, researchers re‐ ported the results of a pilot DCD transplant program in the United Kingdom showing DCD donors increased over‐ all heart transplantation by 28 per cent.

After 30 days, DCD trans‐ plant recipients showed the same survival rate as those who received a heart through conventional donation.

Rao is working to bring the heart-in-a-box technique to Ontario.

"We did 43 transplants last year," Rao said. "We would anticipate that incor‐ porating the DCD procure‐ ment technique would ex‐ pand our transplant program to well over 50 and ap‐ proaching 60 hearts a year."

Rao said delays due to the COVID-19 pandemic emer‐ gency meant his team was only ready to be trained to use the heart-in-a-box tech‐ nology in January. Then provincial procurement poli‐ cies for the technology led to another pause, he said. They are still waiting for equip‐ ment.

Rao said if they'd had the equipment and training, "cer‐ tainly the three hearts that were procured this past week would have all gone to On‐ tario citizens."

In a statement, Ontario Health said it has partner‐ ships and reciprocity agree‐ ments with other Canadian provinces and the Americanbased United Network for Organ Sharing. Donated or‐ gans are shared based on the most critical need.

The heart-in-a-box ap‐ proach "was a collaborative opportunity for Ontario physicians and clinicians to observe and learn from an experienced U.S. organ re‐ trieval team with their spe‐ cialized equipment," the agency said.

Motivated family brings change

Dr. Sam Shemie, an inten‐ sive care physician in Mon‐ treal, is also an organ dona‐ tion advisor for Canadian Blood Services.

"What this shows, the Kingston case, is that a family who is motivated can ad‐ vance the system," Shemie said.

Shemie said use of the technology is imminent in Ontario and other provinces will also likely use it to save lives.

Rao hopes to resume training in the next few weeks.

As of December 31, 2023, there were 118 Canadians waiting for a heart trans‐ plant, according to Canadian Blood Services, which helps provinces coordinate dona‐ tions and transplants.

Lorraine Sherren said her son's legacy of giving started as soon as it could. "He signed up [to donate blood] as his birthday gift to him‐ self," she said.

Last Saturday would've been his 122nd donation, she said.