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NHS doctors were the first to use a ‘dead’ heart transplant technique – previously deemed appropriate only for adults – in children, saving the lives of six young patients last year.
For transplants surgeons usually use hearts donated by patients who have been diagnosed with brain stem deaths but whose hearts are still beating. Recovering the hearts of patients who have suffered cardiac death (which are much more common than brainstem deaths) is considered too risky a prospect.
Marius Berman, 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 to assess if the heart is working well… that is why it will not be sure to recover the heart because we would not know how it is working.
Previously, hearts were transported to recipients in sterile coolers. However, a “heart-in-a-box” machine – called the Organ Care System (OCS), developed by the US company TransMedics – was designed to mimic the human body, keeping the heart warm, beating and pumping blood so that it is safe for transport. to the recipient. The idea behind the machine was to allow the organ to be transported long distances.
In 2015, doctors at RPH pioneered the use of the machine to revive the hearts of donors who had suffered cardiac death. By resuscitating these hearts using the machine, doctors could assess whether the organ was salvageable for transplantation.
The concept worked, and since then, Berman said, “we’ve basically doubled our heart transplant business, every year.” At one point, the new method overtook the traditional method of organ donation after brain death, he added, while the health outcomes for patients remained consistent.
Now, a collaboration between RPH, whose team is recovering the heart, and Great Ormond Street Hospital in London, whose team is implanting the organ, has pioneered the first use of the technique in pediatric transplantation.
Across the UK, the average wait for an adult who needs a heart transplant is almost three years. Patients who need hearts tend to exceed the number of donor hearts available, and children face even longer wait times, as the right organ size has to be found and the rate of donation. consent for organ donation in children is relatively much lower.
Great Ormond Street has 24 children waiting for a heart transplant and between 2014 and 2019 the average wait time was 282 days.
“The wait times for transplants are significantly lower than the RPH than the national average, not because we are better surgeons,” Berman said. That’s because the new approach has saved time and money, he said.
The first child to receive a transplant based on the new approach was Anna Hadley, 15, who was diagnosed with restrictive cardiomyopathy in 2018.
“We’ve always tried to stay positive, but we got the facts – there was a lack of suitable donors and about 40% of children waiting for a heart transplant never get one. It made the 20+ months on the transplant waiting list incredibly difficult, ”said Anna’s father Andrew Hadley. “Five days after the transplant, Anna was walking up and down the hallways, talking to the staff. It was amazing. “
For now, the technology is limited to donors weighing at least 50 kg, but the two hospitals are working on a new machine that will allow donation even from infants, which could usher in an era of transplantation for babies and young children where donors are the rarest. A prototype is ready, and doctors plan to start using the machine by the end of this year.
The cost of using the existing OCS machine is around £ 50,000, but in fact it costs less than having heart patients waiting for organs. Every day in the UK, between 30 and 40 adults are on the urgent transplant list. Each day in intensive care costs £ 2,500, Berman said. “This means that every day [it is costing the NHS] … £ 70,000 to £ 90,000 to have patients wait in hospital.
“Ultimately, this work always relies on families having conversations about organ donation wishes,” said Jacob Simmonds, consultant cardiologist and transplant doctor at Great Ormond Street, “and then, of course, the bravery. to consider giving this precious and saving gift at a time of unimaginable tragedy.
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