Georgia's first heart transplantation from a donor who experienced circulatory death
Emory was one of the first five hospitals to join a groundbreaking new clinical investigation involving hearts reanimated from donors that experienced circulatory death (DCD). The study, Donors After Circulatory Death Heart Trial, utilizes TransMedics's Organ Care System (OCS), to resuscitate and preserve hearts after DCD. What makes this approach novel is that until the advent of this technology, hearts donated for transplantation had to come from a donor that experienced brain death (DBD). Researchers believe this new technology could mean a 30% increase in donated organs available for transplant.
Patient Case Study
Doctors consulted with a 44-year-old female patient admitted to Emory University Hospital in August 2019, with heart failure. She had a history of congenitally corrected L-transposition of her great arteries that resulted in severe systemic (right) ventricular dysfunction as well as systemic atrioventricular valve regurgitation, and heart block.
The patient remained in the hospital and was listed for a heart transplant; however, despite her clinical status she remained at a lower-priority on the donor waitlist. Her standing could not be escalated, yet she required hospitalization to survive. Additionally, since the patient’s blood type was O and blood type O patients not only represent the highest proportion of the waitlist, but also can only receive organs from blood type O donors, her outlook for receiving an expedient organ offer was grim.
The Emory Transplant Center team approached the patient about the study, and she agreed to participate. She was added to the pool of randomized candidates, and at that point, the team began looking at DCD donors for her. In March, she had a DCD organ offer. The transplant team traveled to inspect the heart; they put it on the device and reanimated it. Concluding that it was in good condition, they brought it back to Emory and performed a heart transplant for the patient.
After a successful surgery, the patient recovered well and was finally able to go home to her children after a very long hospitalization. Her follow-up visits have shown that she is in good health with strong heart function, and doctors anticipate she will continue to thrive.
To date, Emory doctors have performed seven heart transplants using organs from donation after circulatory death as part of the study. All patients have recovered well.
Background
While the TransMedics Organ Care System (OCS) has been used in prior research for other types of transplants, its use with hearts from donors after circulatory death is novel. Emory Healthcare is the only healthcare system in Georgia where this approach is being explored.
"This is the forefront of heart transplantation, globally," says Mani Daneshmand, MD, director of the Emory Heart & Lung Transplantation, Mechanical Circulatory Support, and Emory ECMO (Extracorporeal Membrane Oxygenation) Programs. Daneshmand is also the study’s Primary Investigator. "We're excited to be part of this trial; we’re performing transplants for patients who otherwise may have been waiting much longer for suitable organs. Being one of five centers to date in the country doing this groundbreaking research is exciting and in line with the missions of both the Emory Heart & Vascular and Transplant Centers.”
Organ donation after circulatory or brain death
Deceased donor organ donation can happen after brain death (DBD) or, for those who do not meet brain death criteria, after circulatory death (DCD). In the US, greater than 75% of all organs for transplantation come from DBD donors. Before this clinical trial, 100% of all heart donors were DBD.
Using the Organ Care System, doctors take the donated heart, connect it to the OCS machine, and reanimate it. After a period of perfusion, they assess the reanimated heart to see if its function has recovered.
Because of the severe shortage of organs for donation, experts are looking more closely at DCD to expand the donor pool. Doctors believe there could be as much as a 30% increase in donor hearts using new technology such as TransMedics Organ Care System (OCS).
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