A Duke University surgeon revives the “dead” heart on the operating table after stopping the beat for more than five minutes.
The organ was later transplanted into the breast of a 3 month old child, saving his life.
A short report shows that infants with donor hearts continued to show normal cardiac function and at age 6 months without any signs of organ rejection.
Related: Eerie personality changes can occur after organ transplantation
The story is evidence that the concept of “resuscitation on the table” helps, at least for babies, maintain the heart for transplantation.
With the consent of the donor family, the surgeon reactivated the small donor's hearts on the surgical table using an escaped reservoir using oxygen, centrifugal pumps, and a suspended reservoir.
This gimmick had to be custom designed because the current care system that keeps organs alive outside the body is too big for the heart of young children.
Today, in the United States, up to 20% of infants in need die waiting for their hearts.
Most organ donors must declare brain death before giving. After circulatory death, only 0.5% of pediatric heart transplants will be donated. The heart stops beating and the blood flows.
Some critics don't think it's morally correct to remove terminal patients from life support, to have their hearts beat again, and remove them for implantation. There is concern about the declaration of death and how to resuscitate organs in an ethical way.
After circulatory death, the donor's heart may be reoxygenated while still in the donor body. It may also be resuscitated on the operating table using a machine.
Critics argue that if the mind is resuscitated in the donor's body, it will deny the very definition of circulatory death.
Like Duke's surgeons, supporters of resuscitation “on the table” argue that working outside the donor's body reduces ethical concerns. They also note that using organs after circulatory death can increase the donor pool by up to 30%.
Another team of surgeons at Vanderbilt University has a different idea. They devised ways to avoid the most common ethical concerns.
Their techniques aren't trying to revive the donor's heart anytime soon. Instead, save them.
In a brief recent report, the team explains it With an aortic clamp and a flush of cold intake of liquid, they successfully retrieved three donor hearts for implantation.
By closing the heart circulation system, the team continued to rely on the donor's brain for work (this raises ethical concerns about resuscitation).
“Our technology cleans oxygenated storage solutions only in the donor's heart without reviving the heart and without whole body or brain perfusion,” the team explains.
In the first surgery, this technique showed “good initial postoperative results.”
All three donor hearts were successfully implanted with healthy functioning.
“This method of cardiac recovery offers a wide range of applications,” concludes Vanderbilt surgeons.
Both Duke and Vanderbilt reports have been published on NEJM.
