The use of a “dead” heart transplant technique in infants, traditionally considered appropriate only for adults, was pioneered by NHS physicians, saved the lives of six young patients last year.
Typically, surgeons use heart transplants donated from people who are pronounced dead, but whose hearts are still beating. It is considered too dangerous a prospect to recover the hearts of patients who have experienced cardiac death (which is much more common than brain stem deaths).
Marius Berman, a consultant cardiothoracic transplant surgeon at Royal Papworth hospital (RPH) in Cambridge, said that after cardiac death the heart is “like an inflated balloon. So there is no way that we can assess if the heart is working well … that’s why it won’t be safe to retrieve the heart because we wouldn’t know how it functions.”
Machine That Can Restart Hearts
A ‘heart in a box‘ machine, however, called an Organ Care System (OCS), created by the American company TransMedics, was designed to imitate the human body, holding the heart warm, beating and circulating blood so that it is safe for the recipient to be transported.
The concept behind the machine was to allow long distances for the organ to be transported.
Using this pioneering machine, NHS medics have been able to reanimate hearts from donors whose hearts had stopped. The technique has saved the lives of six British children aged from 12 to 16, and the transplants have all taken place during the pandemic.
Doctors could determine whether the organ was salvageable for transplantation by reanimating those hearts using the machine.
Now, the first use of the technique in pediatric transplantation has been pioneered by a partnership between RPH, whose team retrieves the heart, and Great Ormond Street hospital in London, whose team implants the organ.
Across the UK, the average wait is almost three years for an adult who wants a heart transplant. Usually, patients who need hearts surpass the amount of donor hearts available, and children face even longer waiting times, provided the correct size of the organ must be sought and the consent rate for donating children’s organs is comparatively lower.
There are 24 children in Great Ormond Street waiting for a heart transplant, and the average waiting period between 2014 and 2019 was 282 days.
“Waiting times for transplants are considerably lower at RPH than the national average, not because we are better surgeons,” Berman said. It was because time and money were saved by the new strategy, he said.
The first child to receive a transplant based on the new approach was 15-year-old Anna Hadley, who was diagnosed with restrictive cardiomyopathy in 2018.
“We still tried to remain optimistic, but we acknowledged the facts: there was a lack of sufficient donors and there was never one for around 40 per cent of children waiting for heart transplantation. The more than 20 months spent on the transplant waiting list made it extraordinarily difficult said Andrew Hadley.
“Five days after the transplant, Anna was walking up and down the corridors chatting away and high-fiving staff. It was incredible.”
Life-saving gift at a time of unimaginable tragedy
The technology is currently limited to donors weighing at least 50 kilograms, but the two hospitals are working on a new machine that will allow even infants to donate, which will usher in an age of transplantation for babies and young children where donors are the scarcest. A prototype is ready, and by the end of this year, doctors plan to begin using the system.
The per-use cost of the new OCS machine is around £ 50,000, so it still costs less than getting organs waiting for heart patients. There are between 30 and 40 adults on the urgent transplant list every day in the UK. Each day costs £ 2,500 in intensive care, Berman said.
“That means that every single day [it is costing the NHS] … £70,000 to £90,000 for patients to wait in the hospital.”
Ultimately, this work still relies on families having conversations about organ donation wishes, said Jacob Simmonds, consultant cardiologist and transplant physician at Great Ormond Street, “and then, of course, the bravery to consider making this precious, life-saving gift at a time of unimaginable tragedy.”