Hi-tech box that could cut the desperate wait for a new heart

Stephen thomas has plenty of people to thank for being alive. there’s the family of the donor whose heart now beats in his chest; the surgeon and medical staff who performed the 20-hour transplant at harefield hospital, in London; and there’s his loving family in south Wales, who kept his spirits up through decades of ill health.

But stephen, 44, knows that without a revolutionary piece of equipment — the ‘heart in a box’ — the dedication, expertise and love of those people might not have been enough.

the heart in a box — or as it’s known officially, the organ Care system (oCs) — allows a donor heart to function as if it were still inside a human body while it is being transported.

normally a donor heart is transported in ice, but its condition deteriorates due to a lack of blood, meaning the heart must be transplanted within four hours of removal. With the oCs, which is the size of a newborn’s incubator, the heart is kept beating and blood pumped through it, extending the length of time it can be safely transplanted to up to 12 hours.

Blood is taken from the donor before the heart is removed, and mixed with a solution to help the organ function.

once in the sterile chamber of the oCs, the warm, oxygenated blood is pumped through the heart, triggering it to start beating again — if it doesn’t, it can be started with an electric shock.

the box also contains a pump, which pushes blood into the heart, while the beating heart pushes it back out again. the circulating blood is re- oxygenated via an oxygen canister in the box.

the extra time offered by this technology means that if a suitable donor heart is identified many miles away f rom a potential recipient, it can still be transported, increasing the number of heart transplants performed.

‘already we have doubled the number of transplants within one year and that’s with the help of only two machines,’ says andre simon, director of transplantation at harefield hospital, who performed stephen’s surgery. Furthermore, the oCs means donor hearts that have actually stopped beating can also now be transplanted.

In stephen’s case, the new technology gave his surgical team vital extra hours to prepare him for complex heart surgery.

stephen was born with structural abnormalities in his heart that affected the amount of oxygen in the blood and the heart’s ability to pump. he had his first operation at six weeks old and over the following years underwent further surgery to fix his heart valves and keep his heart beating. ‘But I became weaker and weaker and by 2014 I was in a wheelchair,’ he says.

eventually, last December, he was put on the urgent list for a donor heart and was admitted to harefield. Before a donor was found, stephen was being kept alive with an implanted pump inserted in his heart, a temporary measure until a donor organ becomes available.

For patients such as stephen, transplant surgery requires extra time to remove the old heart and the mechanical device, and then to prepare the chest.

‘ the oCs gave us precious surgical time and meant we were fully in control of the operation rather than it being a race against time,’ says mr simon. ‘ this breakthrough changes the game completely and we will be able to save a lot of lives as a result.’

Unfortunately, there are currently only four ‘heart in a box’ units in the country — they’re expensive, each costs around £250,000, plus a further £30,000 every time it is used.

Will pope, whose moving story the Daily mail told two years ago, was one of the first patients to benefit from the technology. then a 19-year- old student, Will had HIs been given only weeks to live.

heart had been damaged by a virus when he was 17, and he’d undergone seven major operations to keep him alive. he was on the urgent list for a donor heart as his health rapidly deteriorated. his story moved many readers to join the donor organ register.

then came the good news. on new Year’s eve in 2013, a donor heart became available. the oCs was used to transport i t to harefield hospital.

although t he surgery was successful, Will had a long and difficult road to recovery but eventually was able to return to Bristol University where he was determined, he says, to make up for lost time.

he became station manager of the university tV station, vicepresident of the comedy society and began writing songs and playing guitar again.

now 22, he’s fit and healthy and requires only an annual check-up. ‘I will always be grateful to my donor for his decision to be an organ donor and to his family for upholding his wishes,’ says Will. ‘In their desperate grief they chose to give me life.

‘there is no doubt in my mind that the more oCs machines there are, the more lives can be saved.’

To join the nHS Donor Register, go to organdonation. nhs.uk or call 0300 123 2323.