Researchers try new ways of preserving more hearts for transplants

WASHINGTON — Two university hospitals are pioneering new ways to expand lifesaving heart transplants for adults and babies — advances that could help recover would-be heart donations that too often go unused.

The new research aims to overcome barriers for using organs from someone who dies when their heart stops. Called DCD, or donation after circulatory death, it involves a controversial recovery technique or the use of expensive machines.

Surgeons at Duke and Vanderbilt universities reported Wednesday that they’ve separately devised simpler approaches to retrieve those hearts. In the New England Journal of Medicine, they described successfully transplanting hearts to a 3-month-old infant at Duke and three men at Vanderbilt.

“These DCD hearts work just as well as hearts from brain-dead donors,” said Vanderbilt lead author Dr. Aaron M. Williams.

Most transplanted hearts come from donors who are brain dead. In those situations, the body is left on a ventilator that keeps the heart beating until the organs are removed.

Circulatory death occurs when someone has a nonsurvivable brain injury but because all brain function hasn’t ceased, the family decides to withdraw life support and the heart stops. That means organs can spend a while without oxygen before being recovered, a time lag usually doable for kidneys and other organs but that can raise questions about the quality of hearts.

To counter damage and determine whether DCD organs are usable, surgeons can pump blood and oxygen to the deceased donor’s abdominal and chest organs — after clamping off access to the brain. But it’s ethically controversial to artificially restore circulation even temporarily and some hospitals prohibit that technique, called normothermic regional perfusion, or NRP.

Another option is to “reanimate” DCD organs in a machine that pumps blood and nutrients on the way to the transplant hospital. The machines are expensive and complex, and Duke’s Dr. Joseph Turek said the devices can’t be used for young children’s small hearts — the age group with the most dire need.

Turek’s team found a middle ground: Remove the heart and attach some tubes of oxygen and blood to briefly assess its ability to function — not in a machine but on a sterile table in the operating room.

They practiced with piglets. Then came the real test. At another hospital, life support was about to be withdrawn from a 1-month-old whose family wanted to donate — and who would be a good…