A transplant method pioneered by Duke University researchers and others is set to expand the availability of hearts from organ donors. In a major study published this month, the authors found that hearts obtained from deceased donors using this method were just as safe to use as those gathered traditionally. If widely implemented, the technique could increase the availability of these lifesaving organs by 30% or more, they say.
Death is defined as the irreversible cessation of the brain and/or circulatory system, including the heart. When only the brain stops working completely, it’s possible to keep a person’s other bodily functions mechanically intact for days, including circulation. Certain organs like the kidneys can be routinely obtained after circulatory death, which typically leaves less time for the organs to be kept viable for a transplant. But until lately, donated hearts were always procured after brain death.
In recent years, surgeons in Europe and Australia have started to successfully perform heart transplants from donations after circulatory death, also known as DCD. In 2019, a team at the Duke University School of Medicine became the first in the U.S. to do the same; two years later, they were the first in the U.S. to perform a pediatric heart transplant of this kind. To accomplish this feat, the surgeons relied on technology developed by the company TransMedics, which allows the heart to keep pumping outside the body while it’s transported to potential recipients.
These early transplants at Duke were part of a larger clinical trial (sponsored by TransMedics) testing out the method at 20 different hospitals. Now, the full results of that trial are finally out and look incredibly promising.
The study was published last week in the New England Journal of Medicine. It involved 180 patients scheduled to receive heart transplants, who were randomly assigned to receive either a traditionally donated heart or a DCD heart. The researchers then kept track of the health and long-term survival of patients who underwent a transplant.
The six-month survival rate in DCD patients—after adjusting for other known risk factors—was about 94%, compared to around 90% in the traditional transplant group. Even when successful, organ transplants can come with plenty of side effects. But there was also no difference in the amount of serious adverse events experienced by patients in either group 30 days later, further indicating the relative safety of the new method.
“This should eliminate any barriers for transplant centers to offer this to their patients because we now have objective, randomized data showing both types of hearts are equivalent,” said study author Jacob Schroder, an assistant professor in the Department of Surgery at the Duke University School of Medicine, in a statement by the university.
Duke and other hospitals have continued to perform DCD heart transplants since the study’s end. As reported by the AP, there were 345 of these transplants in the U.S. last year and 227 so far this year, according to the United Network for Organ Sharing (in 2022, there were a record-setting 4,111 heart transplants in total). But Schroder and his colleagues believe that these transplants can and will become increasingly common now that their findings are out, expanding the pool by at least 30% if not higher.
“Our goal has always been to expand the donor pool to offer heart transplantation to as many patients in need as possible,” said co-author Adam DeVore, associate professor in the Department of Medicine at Duke, in a statement. “By finishing and publishing the DCD Heart study, we offer a clear roadmap for other centers to adopt this practice as well.
