The Beat of the Future Doctors Revive Heart after Circulatory Death
The beat of a reanimated heart filled the halls of Duke University Medical Center this month and made medical history in the United States. The transplant team at Duke University followed suit in Australia and the United Kingdom: Doctors Jacob Schroder, Benjamin Bryner, and Carmelo Milano performed the first reanimated heart transplant procedure in an adult in the United States.
The procedure performed by Duke’s transplant team is referred to as “donation after circulatory death” or DCD. A typical heart transplant procedure is done after an organ donor patient has been declared brain dead, but in this case the brain dead donor was hooked up to a life support machine that pumps blood through the circulatory system, keeping the heart healthy and beating. Based on the usual heart transplants performed over 13 years ago, the average life of a standard transplanted heart tends to be 13 years. However, heart transplants with hearts donated after circulatory death are a relatively new in the medical field and without enough recipients of this kind of heart, there are no studies to conclude on its effectiveness. The DCD approach for heart transplants entails waiting until the heart has stopped beating and the circulatory system ceases to function. The transplant team then works together to collect the other organs being donated and perfuse the heart with cold solution before removing it from the body. Upon removal, the heart is transfused with warm blood in the TransMedic Organ Care System until it begins to beat once again. Once the recipient of the heart is prepped for surgery, the heart is transplanted with the typical heart transplant procedure. While the heart’s muscle cells regain strength, the impact of circulatory death on the coronary artery endothelial cells is unknown. Because injury to the endothelial cells is the main cause of long-term failure in typical heart transplants, doctors are hesitant to practice this procedure.
Regardless of the unknown long-term function of reanimated hearts medical centers in the UK and Australia have been using this approach for the last few years. The Papworth Hospital, located in the UK, has managed to complete 74 DCD procedures and studies show that four years after transplant, these hearts are just as functional as standard heart transplant hearts.
I had no clue that reanimating organs, let alone reanimating a heart, would be a possibility but the DCD procedure is proof that it is a reality. After hearing of this procedure, my parents are concerned about the ethical and moral implications of reanimating human organs for transplantation and even referred to this procedure as a “science-fiction frankenstein approach.” However, as long as the patient is a donor and dead there is no lawful implication in reanimating an organ to potentially save the life of another. You or someone you know may need this procedure and it’s important to be aware that the risks haven’t been fully explored. In the future the DCD transplant procedure may prove to be as efficient long-term as standard heart transplants so I recommend keeping up with medical publications to stay informed. This procedure is medical innovation at it’s best and with further advancements in medical procedures, DCD procedures may have the potential to save countless additional lives every day at little to no cost.