a new method of heart transplant that uses machines to resuscitate donor hearts from deceased people is just as good as traditional heart transplant, a new study finds. If the procedure is widely adopted in the US, the donor pool could be expanded by 30%.
The adjusted six-month survival rate of patients who underwent the new method was 94%, compared to 91% in patients who underwent the traditional method, according to the study published in the New England Journal of Medicine Wednesday, the first large randomized trial comparing the two procedures.
After one year, the survival rate was 93% for patients who received the resuscitated hearts, versus 85% for those who received hearts using the traditional procedure, according to the study, which was funded by TransMedics, the company that makes the heart machine.
Doctors in Australia and the United Kingdom were the first to use this new method. US surgeons later performed the first in the country in 2019. While use of the procedure has since increased, it is still used in only a small minority of cases, accounting for about 6% of all heart transplants in the US in 2021.
“Hopefully, this study shows people that this is an equivalent treatment and should be the standard of care for all recipients,” said Jacob Schroder, first author and heart transplant surgeon at Duke University. “As a medical community, we should understand that and overcome the historical notion that this can’t be done.”
The traditional method of transplantation involves taking hearts from donors who are brain-dead and then placing the hearts immediately in a cold store for shipping.
The new method uses donations after circulatory death (DCD) from people who have suffered severe neurological injury and are on life support, but do not meet the strict definition of brain death. Once cleared, life support is withdrawn and the transplant team waits for the donor to die. Then the team goes in, puts the heart into a machine that circulates blood through it and keeps it functional through transport.
Jacob Schroeder
The study included 180 participants, with 90 patients in each group. Not only did patients in the DCD group have similar – if not better – survival outcomes, they also received their transplant a little faster, waiting an average of 24 days compared to 31 days for patients in the traditional group.
Schroder noted that while the DCD method is costly to perform because of the machine, it could also provide cost savings if patients spend less time in the hospital before receiving their transplant.
However, patients in the DCD group had more dysfunction with their transplanted heart – 22% compared to 10% of those in the traditional group. However, none of the patients in the DCD group had to undergo retransplantation, while two people in the traditional group did.
Maziar Khorsandi, a cardiothoracic surgeon at the University of Washington, who executed the first DCD heart transplant in the Pacific Northwest, said “the results are quite reassuring.”
Since his center began these procedures about a year ago, their workload has increased by about 20%, he said. It is difficult for a center to adopt this method as the machines are expensive and transplant teams need to be trained in its use, yet the method has “revolutionized what we do and how to make organs more available to patients who suffer from heart failure and are actively on the waiting list.”
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