NHS doctors in the UK have pioneered the use of a ‘dead’ heart transplant technique – previously deemed suitable only for adults – in children, saving the lives of six young patients last year.
Retrieving the hearts of patients who have suffered cardiac death (which are far more common than brain stem deaths) has always been considered too risky a prospect.
However, the new technique, called an Organ Care System (OCS), developed by the American company TransMedics – was engineered to emulate the human body, keeping the heart warm, beating and pumping blood so it is healthy for transport to the recipient. The idea behind the machine was to allow for the organ to be transported across long distances.
In 2015, doctors at Royal Papworth Hospital pioneered the use of the machine to revive hearts from donors who had suffered cardiac death. By reanimating those hearts using the machine, doctors could assess whether the organ was salvageable for transplantation.
The concept worked, and since then, said Marius Berman, consultant cardiothoracic transplant surgeon at Royal Papworth, “we have essentially doubled our heart transplant activity, every single year.” The new method overtook the traditional way of organ donation after brain death, he added, while health outcomes for patients have remained constant.
Now a collaboration between RPH, whose team retrieves the heart, and Great Ormond Street hospital in London, whose team implants the organ, has pioneered the first use of the technique in paediatric transplantation.
“No one else in the world is currently doing this,” said Berman. “It’s been an incredible multi-institutional and multidisciplinary team effort to make this possible, involving everyone from the specialist nurses in organ donation and retrieval, transplant coordinators, physicians and surgeons.
Across the UK, the average wait for an adult who needs a heart transplant is nearly three years. Children face even longer waiting times, given the right organ size must be found and the consent rate for child organ donation is relatively much lower. Great Ormond Street has 24 children waiting for a heart transplant, and between 2014 and 2019 the average waiting time was 282 days.
“Transplant waiting times are significantly lower at RPH than the national average, not because we’re better surgeons,” said Berman. It was because the new approach saved time and money, he said.
Currently, the technology is limited to donors who weigh at least 50kg, but the two hospitals are working on a new machine that will enable donation from even infants, which could usher in an era of transplantation for babies and young children where donors are the most scarce. A prototype is ready and the doctors expect to start using the machine by the end of this year.
The per-use cost of the existing OCS machine is about £50,000, but in effect it costs less than having heart patients waiting for organs. Every day in the UK there are between 30 to 40 adults on the urgent transplant list. Each day in intensive care costs £2,500, said Berman. “That means that every single day [it is costing the NHS] … £70,000 to £90,000 for patients to wait in the hospital.
The breakthrough is expected to allow a big expansion in the number of donor hearts available, reduce post-operation complications, speed up recoveries, increase transplant survival rates and save hundreds of lives.