New heart transplant method could expand donor pool by 30%, Duke researchers find
Until recently, if a heart stopped beating, it couldn’t be donated.
Donor hearts typically come from patients determined to be brain dead, from which doctors can extract the beating organ and transplant it into its new owner.
But a new study from Duke researchers found that using a heart that has been “reanimated” by a machine works just as well as traditional transplants. This method could expand the pool of heart donors by 30%, said Dr. Adam DeVore, a Duke researcher and author on the paper.
DeVore said this method allows doctors to salvage hearts from a group of patients who previously had been unable to donate.
Even though they often had permanent neurological injuries and their families wanted to donate their organs, if the patient didn’t meet the strict medical definition of “brain dead,” he or she was not allowed to donate an organ.
Instead, families would have to withdraw care until their hearts stopped, rendering them ineligible for donation.
But in 2019, Duke researchers wondered whether they could use existing technology, commonly referred to as a “heart in a box,” to make use of those organs. Inside a sterile plastic bag, the heart is attached to tubes and drains that circulate warm blood while it is carted to the operating room.
Using this technology, a team of transplant doctors at Duke University Hospital became the first U.S group to successfully transplant a heart after “circulatory death” in December 2019.
With several other large medical centers across the country, they enrolled participants in the first large, randomized trial to test the method’s efficacy.
Patients waiting for donated hearts who wanted to participate in the study were randomly assigned to be on the status quo donor list or the list that would qualify them for a reanimated heart if one became available.
After patients had spent six months with their new hearts, the researchers compared outcomes and found there was no statistical difference.
The survival rate of patients who received the new method was 94% while the survival rate for those who received the traditional transplantation method was 90%. It’s still unclear why survival appears to be slightly better for patients who received the reanimated hearts, DeVore said.
Randomized trials like this are rare in transplant research.
“Transplants are just a really high-stakes game,” he said.
This study gives doctors concrete evidence that this strategy is safe and effective, which DeVore hopes will convince other transplant centers to adopt the method.
“It’s a big deal because it doesn’t require some new change in policy,” he said. “These families already wanted to donate.”
Duke’s own heart transplant clinic has greatly benefited by drawing from this new pool of donors. DeVore said the program has doubled in size in the last year, which he credits in part to the new method.
Teddy Rosenbluth covers science and health care for The News & Observer in a position funded by Duke Health and the Burroughs Wellcome Fund. The N&O maintains full editorial control of the work.
This story was originally published June 23, 2023 at 6:00 AM with the headline "New heart transplant method could expand donor pool by 30%, Duke researchers find."
