Dead hearts revived for transplant with new medical technology

If you need a heart transplant in the UK, you’re likely to be waiting a while – on average six months. With something as serious as a heart transplant, that wait will be too long for some, with some estimates suggesting that around 15% of patients will die waiting for a replacement ticker to come available.

The main reason for this is that donor hearts can only be taken from living subjects – patients who have suffered brain-death have their organs removed while they’re still functioning, allowing for a safe transplant. In short, there aren’t that many donors that meet these requirements, so waiting lists for heart transplants tend to be long and stressful.

That may change, thanks to a brand-new invention developed by TransMedics, a device that has already been used successfully in 15 transplants in the UK and Australia. Put simply, it allows dead hearts to be “reanimated” and used again to save someone else’s life: the “heart-in-a-box”.

Unlike current transplants, where the organ is chilled to around 4°C to reduce the metabolic activity, the device keeps the heart warm. It’s then transferred to a sterile chamber on a wheeled cart, where tubing is clamped onto the heart giving it a steady supply of blood, oxygen and nutrients. You can see what this looks like in the video below, but for the squeamish: don’t say I didn’t warn you.

https://youtube.com/watch?v=j9_7jjUoMpY

There are three things blocking the heart-in-a-box from transforming heart transplants as we know them: practical, financial and ethical.

The practical one isn’t too much of a bar: the heart needs to be from someone recently deceased – you can’t reanimate long-dead hearts, as you might imagine. Still, this does mean the heart-in-a-box needs to be in the right place at the right time, which leads us to problem number two: financial.

The heart-in-a-box costs $250,000 (around £160,000), making it an expensive piece of technology for every hospital to have ready to deploy at any given moment.

The ethical one is where things get really interesting. Previously, if someone’s heart stopped and they died, they would be officially dead. But how can they be, if we can remove the heart, reanimate it and give it to someone else? Or as medical ethicist Dr Robert Truog said to Technology Review, “How can you say it’s irreversible, when the circulatory function is restored in a different body? We tend to overlook that because we want to transplant these organs.”

“My argument is that they are not dead, but also that it doesn’t matter. They are dying and it’s permissible to use their organs. The question is whether they are being harmed, and I would say they are not,” he added.

If these issues can be overcome, then the technology could be transformatory. The British Heart Foundation estimates that just eight out of every ten people “receive the heart transplant they require”, and there were only 181 transplants carried out at seven hospitals last year. The heart-in-a-box has the potential to ensure that this number increases dramatically, and that the lottery of the waiting list becomes a thing of the past.

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