Illinois

Northwestern transplants hearts using the heart-in-a-box device.

For the first time in Illinois, surgeons have successfully taken a heart that has stopped beating inside a patient and transplanted it into another person using a new device that sounds like fiction.

Surgeons at Northwestern Memorial Hospital announced Wednesday that they performed a heart transplant on Oct. 12 using a device called a “heart in a box.” Doctors hope the breakthrough will make more hearts available for transplant. About 3,400 people nationwide are currently waiting for a heart transplant, including 182 in Illinois.

Hearts are usually only considered for transplant if the donor is brain dead, but the donor’s heart is still beating inside the body on its own or with mechanical assistance. Sometimes this can happen after a traumatic injury or drug overdose. In such cases, the heart is removed from the donor’s body and placed on ice for transport to the recipient, which should take about four hours.

However, the heart-in-a-box device allows surgeons to use hearts from donors suffering from circulatory death when the heart and respiratory system stop working. Once the heart stops beating, surgeons have about 30 minutes to retrieve it and place it in the device. The device then resuscitates him and keeps him alive by pumping warm, oxygenated blood through him until he can be transplanted into a donor.

The patient who received the heart at Northwestern is doing well and was preparing to go home earlier this week, said Dr. Benjamin Breiner, associate director of heart transplantation and mechanical support and director of the advanced donation program at Northwestern Medicine’s Blum Cardiovascular Institute. .

“I think this is one of the most significant advances in heart transplantation in the last few decades,” Breiner said. “It’s opening up a lot of hearts that were kind of thrown away.”

Breiner believes the device could increase the number of heart transplants by about 20-30% in the Northwest region and across the country. Northwestern now performs about 30 to 40 heart transplants a year, Breiner said.

Until now, patients usually could not be considered as potential donors unless they were brain dead, limiting the number of hearts available. New technology allows surgeons to take hearts from patients who aren’t technically brain dead but have no hope of recovery. These patients may also have suffered an injury or drug overdose and lost almost all brain function, but are not considered dead because they may have a preserved reflex or a small trickle of blood going to the brain, Breiner said. They are not considered donors when there is no hope left, he said.

When the patient reaches this point, the patient’s family may decide to take the person off life support so that the person stops breathing and the heart stops beating. The person then dies of circulatory failure, and surgeons can retrieve the heart and place it in a device for transport to another patient.

Because the device keeps the heart working, surgeons have more time to transplant it than using traditional methods. The device can keep a heart viable for eight to nine hours, compared to four to five hours when a stopped heart is kept on ice before a transplant.

“With traditional methods, we’re limited in terms of the amount of time and distance we can cover,” said Dr. Duc Thinh Pham, director of heart transplantation and mechanical circulatory support at the Northwestern Blum Cardiovascular Institute. “This device allows us to travel longer distances and for a (longer) travel period.”

The device also gives surgeons more time to study the condition of the heart, looking for signs of damage or coronary disease, before it is transplanted into another patient.

“It used to be too much of a risk to take someone’s heart that had already stopped and implant it and hope it would work,” Breiner said.

Only a handful of US hospitals have used the technology to perform heart transplants, although hospitals in the UK and Australia have been using it for years, Northwestern reports. The technology is similar to that used for liver, lung and kidney transplants in recent years, including the Chicago area.

The new portable device is called the TransMedics Organ Care Heart System and was recently approved by the US Food and Drug Administration for use with donor organs after circulatory death.

A paper published in the journal Cureus earlier this year noted that the technology has the potential to increase the number of hearts available for transplant, but it is expensive and can be more difficult to transport than hearts preserved using ice.

Pham called the device one of the biggest developments he’s seen in heart transplants and said it could benefit more heart failure patients. He also encourages people to sign up for organ donation. In Illinois, people can register by going to https://apps.ilsos.gov/organdonorregister/ or by calling 1-800-210-2106.

https://www.chicagotribune.com/business/ct-biz-northwestern-heart-in-a-box-donor-transplant-20221102-fdxdtyta5zftfdi3wst5bmalei-story.html#ed=rss_www.chicagotribune.com/arcio/rss/category/news/

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