Heart transplants enable an amazing reversal in quality of life for recipients of donor hearts, allowing them to return to a busy and full life, with a vastly enhanced life expectancy. One of the barriers to more success in this field is the supply of organs, which continues to be outstripped by demand worldwide. There has also been a steady decline in the number of hearts available for heart transplantation over the last decade. 

Renowned heart transplant surgeon, Stephen Large, a consultant surgeon and leading member of the senior team at Papworth Hospital NHS Foundation Trust, has taken on the challenge of donor organ supply over the last 10 years with supportive funding from the Evelyn Trust.

Since the 1970s, donor hearts have been donated by the families of patients who were diagnosed with brain death – DBD hearts – as these hearts had not endured a period without blood flow. It became clear that if donor hearts could be used after circulatory-determined death – DCD hearts – it would mean many more opportunities for donation. Transplant teams around the world set to work to investigate ways to avoid damage to the DCD hearts once blood ceased to flow through them after the death of the patient.

“Initially, they had success in the South Africa and then the US when both donor and recipient were in the same hospital and the transplant was immediate. It was clear, though, that to maximise the potential of DCD hearts it would be essential to find a way to transport them. This led to the development of the ‘organ care system’ which perfuses the heart while it is transported. This new approach was first used successfully in Sydney, Australia and since 2015 we have been performing DCD heart transplants at Papworth Hospital using the organ care system. What we have been able to prove with our research here is that it’s also possible to perfuse the heart – indeed to perfuse multiple organs – within the donor’s body for a period of time by using a machine to restart circulation of the donor’s blood. This restarts the heart, reduces the risk of damage to the heart, or other organs and maximises the chances of successful transplantations. The equipment we have developed to carry out this groundbreaking work has been funded by a generous grant from the Evelyn Trust,” explains Stephen Large.

This worldwide challenge of expanding the donor heart pool has been taken up by several research teams working collaboratively. The Papworth team is pursuing the possibilities, working closely with the clinical transplant team at Addenbrooke’s, Stanford University, California and the Canadian Research Centre in Winnipeg.

“We believe that we can increase the heart transplant activity in this country by at least one third with a successful programme of DCD heart resuscitation and transplantation. We have every reason to believe that DCD hearts will offer equivalent life expectancy to recipients - although it’s too early to have firm evidence for that - but the future for heart transplant patients looks very bright.”

To find out more about this exciting advance in transplant research, visit http://www.dcdheart.com/what-is-dcd/