Donor hearts are traveling longer distances with machine perfusion

In places like Australia, where metropolitan areas are separated by an entire continent, donor hearts used to go unused simply because transplant teams couldn’t get the organ to a recipient in time.

“If there isn’t a recipient for an available heart in Perth but there’s a match in Sydney, that’s nearly 2,000 miles of travel, or a five-hour flight,” said Emily Granger, MBBS, cardiothoracic and heart and lung transplant surgeon at St. Vincent’s Hospital, Sydney, Australia. “Add to that a couple of hours for retrieval and preparation, and that’s a seven-hour journey.”

Dr. Granger addressed organ transportation time at today’s Annual Meeting and Scientific Sessions of the International Society of Heart and Lung Transplantation (ISHLT) in Boston.

“We’ve focused much of our research at St. Vincent’s on ensuring that we can protect and preserve the donor heart not only for a long distance but also for a long time,” she said.

Until recently, donor hearts had to be transported in a portable cooler, which gave transplant teams six hours to get a donor heart implanted. The inception of machine perfusion, in which a device pumps a blood-like solution through the donor heart during transport, has significantly extended that window.

St. Vincent’s, a pioneer of machine perfusion, began using the technology in 2014 for hearts donated following circulatory death (DCD). Today, machine perfusion is used in over half of the center’s heart transplants.

“We recognized that we needed a system that would enable us to span the country,” she said. “We knew we had to remove time from the equation.”

St. Vincent has pushed the limits of normothermic machine perfusion (NMP), in which the heart is perfused and preserved at approximately 35 degrees Celsius, for up to 8 hours. Other Australian units have even used the system for 10 hours.

“Ten years ago, we had to refuse donor organs because of time constraints,” she said. “Now we can accept organs from regions we never thought were possible and be confident they’ll work.”

She said in the near future, it may be possible to push the boundaries even more.

“We could actually look at an international exchange of donor hearts to allow transport between countries,” she said.

Australia already retrieves donor organs from New Zealand. However, machine perfusion could allow transplantation teams to travel to the Pacific Islands and Asia.

“There are a significant number of patients on our transplant list that are very difficult to match to a donor,” she said. “The answer for them could be a donor from a slightly different genetic population than we have in our local area. Their ideal donor might actually live in a different country.”

Research conducted at St. Vincent’s has shown that outcomes for heart transplants involving machine perfusion are comparable to transplants performed without it.

“We looked specifically at the primary graft function in the transplanted heart and found no difference across modalities,” she said. “We like to think that we’re removing the impact of time by using machine perfusion.”

Dr. Granger said the technology represents a true sea change for heart transplant teams.

“When I began my career as a transplant surgeon, we just had a portable cooler,” she said. “The space has totally transformed, and the only thing limiting us at the moment is our imagination.”

Provided by
International Society for Heart and Lung Transplantation

In places like Australia, where metropolitan areas are separated by an entire continent, donor hearts used to go unused simply because transplant teams couldn’t get the organ to a recipient in time.

“If there isn’t a recipient for an available heart in Perth but there’s a match in Sydney, that’s nearly 2,000 miles of travel, or a five-hour flight,” said Emily Granger, MBBS, cardiothoracic and heart and lung transplant surgeon at St. Vincent’s Hospital, Sydney, Australia. “Add to that a couple of hours for retrieval and preparation, and that’s a seven-hour journey.”

Dr. Granger addressed organ transportation time at today’s Annual Meeting and Scientific Sessions of the International Society of Heart and Lung Transplantation (ISHLT) in Boston.

“We’ve focused much of our research at St. Vincent’s on ensuring that we can protect and preserve the donor heart not only for a long distance but also for a long time,” she said.

Until recently, donor hearts had to be transported in a portable cooler, which gave transplant teams six hours to get a donor heart implanted. The inception of machine perfusion, in which a device pumps a blood-like solution through the donor heart during transport, has significantly extended that window.

St. Vincent’s, a pioneer of machine perfusion, began using the technology in 2014 for hearts donated following circulatory death (DCD). Today, machine perfusion is used in over half of the center’s heart transplants.

“We recognized that we needed a system that would enable us to span the country,” she said. “We knew we had to remove time from the equation.”

St. Vincent has pushed the limits of normothermic machine perfusion (NMP), in which the heart is perfused and preserved at approximately 35 degrees Celsius, for up to 8 hours. Other Australian units have even used the system for 10 hours.

“Ten years ago, we had to refuse donor organs because of time constraints,” she said. “Now we can accept organs from regions we never thought were possible and be confident they’ll work.”

She said in the near future, it may be possible to push the boundaries even more.

“We could actually look at an international exchange of donor hearts to allow transport between countries,” she said.

Australia already retrieves donor organs from New Zealand. However, machine perfusion could allow transplantation teams to travel to the Pacific Islands and Asia.

“There are a significant number of patients on our transplant list that are very difficult to match to a donor,” she said. “The answer for them could be a donor from a slightly different genetic population than we have in our local area. Their ideal donor might actually live in a different country.”

Research conducted at St. Vincent’s has shown that outcomes for heart transplants involving machine perfusion are comparable to transplants performed without it.

“We looked specifically at the primary graft function in the transplanted heart and found no difference across modalities,” she said. “We like to think that we’re removing the impact of time by using machine perfusion.”

Dr. Granger said the technology represents a true sea change for heart transplant teams.

“When I began my career as a transplant surgeon, we just had a portable cooler,” she said. “The space has totally transformed, and the only thing limiting us at the moment is our imagination.”

Provided by
International Society for Heart and Lung Transplantation