Heart transplants from donors who have suffered circulatory death may now be performed safely and effectively using a method that resuscitates donor hearts. A new clinical trial was conducted across fifteen US-based transplant centres, using the Organ Care System by medical device company TransMedics, which “revived” donor hearts by perfusing them with warm, oxygenated blood and allowing doctors to test their function. The approach was found to be on par with traditional heart transplants, according to the New England Journal of Medicine. Of 80 patients who received resuscitated donor hearts, 94% were alive six months later, compared with 90% of the transitional group. Experts believe the method could boost the national supply of donor hearts by about 30%.
Additional Piece:
Circulatory death is a medical term that refers to irreversible cessation of circulatory and respiratory functions, the last stage of dying for many people. It’s now possible to harvest heart organs from donors that have undergone circulatory death using a new transplantation method. This is a major breakthrough in the field of heart transplantation since donors’ hearts used to be taken from persons who had been declared brain dead, all brain function had stopped but the heart and other organs were being maintained by machines. The new approach allows doctors to revive a heart once it has stopped beating, test its function to ascertain if it’s suitable for transplantation, and then perform the transplantation.
This new method represents a significant expansion in the supply of heart transplant organs that may not have been eligible for transplantation because of the nature of donors’ deaths. Traditionally, the heart, which had stopped beating in cases of circulatory death, couldn’t be used for transplant, and this has been a major constraint in the availability of donor hearts for transplantation. According to Dr. Jacob Schröder, assistant professor, surgeon, and surgical director of the Heart Transplant Program at Duke University in Durham, NC., “This is the most important thing that has happened in heart transplantation since heart transplantation”.
The new approach also gives medical personnel more freedom to consider more organ donors. In recent years, donor hearts have been harder to come by due to the high standards required in the screening process of heart donors. In 2022, a record 4,111 heart transplants were performed in the US, with 3,350 Americans currently awaiting a heart transplant. The DCD approach could expand the national supply of donor hearts by an additional 30%, giving hope to those waiting for heart transplantations.
Doctors who have long searched for new methods of harvesting donor hearts are ecstatic about this breakthrough. With DCD hearts, the limitations on the availability of donor hearts for heart transplantations will be eliminated. Despite being linked with higher risk factors for a patient after transplant, the statistics show ho the survival rate is similar to those who received donor hearts in the traditional method. This breakthrough has the potential to change the face of heart transplantations in the United States and beyond. This method is a result of technological improvements that corroborate the advancements made in biotechnology in the last decade. It will represent a significant milestone, which will positively impact people’s quality of life by lengthening it and lessening their dependency on medical machines. Lives will be saved, and the conditions of patients will be improved by harnessing this technology’s power.
Summary:
A clinical trial has successfully tested a new transplant method that allows doctors to perform heart transplants from donors who have succumbed to “circulatory death.” Using a device known as a “heart-in-a-box” that perfuses the donor’s heart with warm, oxygenated blood, doctors can revive a heart that has stopped beating. The trial found that the resuscitated donor heart approach is as effective as traditional heart transplants and could help boost the national supply of donor hearts by about 30%. In 2022, a record 4,111 heart transplants were performed in the United States, but currently, there are 3,350 Americans who are awaiting a heart transplant. This breakthrough represents a significant milestone that will positively impact people’s quality of life by lengthening it and lessening their dependency on medical machines. Lives will be saved, and the conditions of patients will be considerably improved.
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By Amy Norton
HealthDay Reporter
THURSDAY, June 8, 2023 (HealthDay News) — A new transplant method that “resuscitates” donor hearts appears safe and effective, a new clinical trial has found, in a breakthrough that could substantially expand the supply of hearts from Available donors in the United States. state
The trial tested an approach that allows doctors to transplant hearts from donors who have succumbed to “circulatory death,” meaning the heart has stopped beating. Traditionally, heart transplants could only be performed with a heart from a life-sustaining donor who had been declared brain dead. That means all brain function has ceased, but the heart and other organs are being maintained by machines.
But thanks to a new “heart-in-a-box” device, doctors can now take a donor heart that has stopped beating and essentially revive it, and test its function to determine if it’s suitable for a transplant.
In the new trial, conducted at 15 US transplant centers, doctors found the approach was on par with traditional heart transplants.
Of 80 patients who received a resuscitated donor heart, 94% were alive six months later. That compared with 90% of 86 patients who received hearts from brain-dead donors.
Experts said the results, published June 8 in the new england journal of medicine they are “exciting”.
The transplant approach, known as donation after circulatory death (DCD), could expand the national supply of donor hearts by about 30%, the lead researcher said. Dr. Jacob Schrödersurgical director of the heart transplant program at Duke University in Durham, NC
“That’s still not enough,” Schroder said. “But I would say this is the most important thing that has happened in heart transplantation since heart transplantation.”
DCD hearts come from donors who have suffered devastating injuries that have left them on life support with no chance of recovery. In most cases, they have severe brain injuries that do not meet the strict criteria used to declare brain death. Instead, they succumb to “circulatory death” after the family decides to withdraw life support.
In the United States, DCD transplants have long been performed with other organs, including the kidneys, liver, and lungs. Those organs, particularly the kidneys, can tolerate a period of oxygen deprivation after circulatory death. The heart, which has stopped beating in cases of circulatory death, has been the exception.
“For a long time,” Schroder explained, “we didn’t have the methods to preserve and resuscitate the heart.”
But in recent years, with the rise of new technology, transplant centers in some other countries have been using DCD hearts. Small studies in Australia and the United Kingdom have indicated that transplant recipients do just as well with DCD hearts as with conventional transplants.
The new trial is the first to test the approach in the United States, using the Organ Care System made by TransMedics, a Massachusetts-based medical device company that funded the study. It is a “heart in a box” device that perfuses the donor’s heart with warm, oxygenated blood. In addition to resuscitating the heart, the device also allows doctors to test its function.
The trial enrolled 180 adult heart transplant candidates, half receiving a DCD heart and the other half receiving one from a brain-dead donor.
At six months, the researchers analyzed the results of 166 transplant recipients. Overall, survival rates were comparable between the two groups, as was the risk of serious problems with the new heart.
Patients in the DCD group were more likely to have significant heart function problems soon after transplant: 15% did, compared with 5% in the standard transplant group. But the problems were manageable.
Right now, about 20 US transplant centers perform DCD heart transplants, according to Schroder. But he said he believes they should now be considered “standard of care.”
Other experts hoped the findings would encourage more transplant programs to adopt the approach.
The field of heart transplants is, by nature, “very conservative,” he said. Dr. Nancy Sweitzer, heart failure specialist and professor at Washington University School of Medicine in St. Louis.
Transplant teams want to make sure they’re “getting a good deal” when they give patients a new heart, Sweitzer said.
“I think these findings will lead more programs to move forward with more confidence,” said Sweitzer, who wrote an editorial published with the study.
Dr David Klassen He is the medical director of the United Network for Organ Sharing (UNOS), the nonprofit organization that manages the national waiting list for transplants. He said that compared to other organ transplants, heart transplants have always been more limited by donor supply.
According to Klassen, the new findings confirm what everyone thought would be the case. But having solid data from a clinical trial is important, she said, to bolster programs’ confidence in DCD heart transplants.
Schroder said he thinks it’s time to move away from the idea that heart transplants are constrained by a “supply problem.” Instead, he believes that many programs can be less restrictive on what they consider to be a good donor heart.
In 2022, a record 4,111 heart transplants were performed in the United States, according to UNOS. Currently, there are 3,350 Americans on the waiting list to receive a heart.
More information
The United Network for Organ Sharing has more about heart transplant.
SOURCES: Jacob Schroder, MD, assistant professor, surgeon, and surgical director, heart transplant program, Duke University School of Medicine, Durham, NC; David Klassen, MD, medical director, United Network for Organ Sharing, Richmond, Va.; Nancy Sweitzer, MD, PhD, professor of medicine, Washington University School of Medicine in St. Louis; new england journal of medicine June 8, 2023
https://www.webmd.com/heart-disease/news/20230608/new-approach-to-transplants-could-boost-supply-of-donor-hearts?src=RSS_PUBLIC
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