News – UK – British doctors pioneered the use of the “heart in a box” transplant technique in children


The procedure, previously only considered suitable for adults, saved the lives of six young patients in the past year

NHS doctors pioneered the use of a “dead” heart transplant technique in children that was previously only suitable for adults, and saved the lives of six young patients in the past year

Surgeons typically use to transplant hearts donated by patients who have been pronounced dead but whose hearts are still beating.Retrieving the hearts of patients with cardiac death (far more common than brainstem deaths) is considered too risky viewed

Marius Berman, a consultant cardiothoracic transplant surgeon at the Royal Papworth Hospital (RPH) in Cambridge, said that after cardiac death, the heart is “like an inflated balloon, so there’s no way we can tell if the heart is working well Therefore it is not safe to regain the heart as we do not know how it works ”

Previously, hearts were transported in sterile cool boxes for intended recipients. A “Heart in a Box” machine – called Organ Care System (OCS) – developed by the American company TransMedics – was developed to emulate the human body, warm the heart to hold, beat and pump blood so that it is healthy for transport to the recipient. The idea behind the machine was to allow the organ to be transported over long distances

In 2015, RPH doctors pioneered the use of the machine to resuscitate the hearts of donors who had suffered cardiac death. By resuscitating those hearts with the machine, doctors were able to assess whether the organ could be saved for transplant

The concept worked, and since then, Berman said, “We have essentially doubled our heart transplant activity every year“At some point the new method overtook the traditional way of organ donation after brain death, while the health results for the patients remained constant

Now, a collaboration between RPH, whose team is retrieving the heart, and Great Ormond Street Hospital, London, whose team is implanting the organ, pioneered the first use of this technique in pediatric transplants

Across the UK, the average waiting time for an adult in need of a heart transplant is nearly three years, patients in need of hearts tend to exceed the number of donor hearts available, and children have even longer waiting times as the right organ size is found and the approval rate for organ donation from children is relatively much lower

24 children are waiting for a heart transplant on Great Ormond Street Between 2014 and 2019 the average waiting time was 282 days

“Waiting times for transplants for RPH are significantly lower than the national average, not because we are better surgeons,” said Berman. The new approach has saved time and money, he said

The first child to receive a transplant using the new approach was 15-year-old Anna Hadley, who was diagnosed with restrictive cardiomyopathy in 2018

“We have always tried to stay positive, but we got the facts – there was a lack of suitable donors and around 40% of children waiting for a heart transplant never get one. That made up the more than 20 months The transplant waiting list was incredibly difficult, “said Anna’s father Andrew Hadley.” Five days after the transplant, Anna was walking up and down the corridors chatting to high-profile staff. It was amazing. “

Currently the technology is limited to dispensers weighing at least 50 kg However, the two hospitals are working on a new machine that will also be able to donate infants This could usher in an era of transplants for babies and toddlers. Donors are the rarest A prototype is ready and doctors expect the machine to be operational by the end of this year

The costs per use of the existing OCS device are approx 50£ 000 but less than waiting heart patients for organs In the UK, between 30 and 40 adults are on the urgent transplant list every day. Every day in intensive care costs 2500 pounds, Berman said, “That means that every day [it costs the NHS] … 70000 to 90000 pounds for patients waiting in hospital

“Ultimately, that work still depends on families having discussions about organ donation requests,” said Jacob Simmonds, consulting cardiologist and transplant doctor on Great Ormond Street”And then of course the bravery to think about making this precious life Save a gift in a time of unimaginable tragedy ”

National Health Service, Organ Transplant, Heart Transplant

News – UK – British doctors pioneered the use of the “heart in a box” transplant technique in children