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Northwestern Medicine performs Illinois' first successful 'heart in a box' transplant

by John R. Fischer, Senior Reporter | November 08, 2022
Cardiology Rad Oncology
Surgeons at Northwestern Medicine performed the first successful transplant of a DCD donor heart in Illinois. (Photo courtesy of Northwestern Medicine)
Surgeons at Northwestern Medicine have successfully transplanted the first donated heart from a circulatory death (DCD) patient, in Illinois.

The procedure relied on the TransMedics Organ Care System (OCS), a "heart in a box" technology that resuscitates a heart until the transplant, and the only system used in DCD heart transplantation worldwide.

Most donations come from brain dead patients, with the heart continuing to beat via mechanical assistance. DCD ones come from those who will not recover but do not meet brain dead criteria and cannot be declared dead until the heart or respiratory system shut down.

Surgeons then remove the organ within minutes and connect it to the OCS, which reanimates it and simulates the inside of the human body pumping warm, oxygenated blood through the heart while it is transported.

The number in need of transplants outweighs the number of available hearts, with only 3,500 procedures performed in 2021, despite there being over 7,000 patients on the U.S. heart transplant list. And 5,000 more are added each year.

Use of the OCS could increase available donor hearts up to an estimated 30%.

“With standard hypothermic preservation, we only have about four hours to get the heart from the donor to recipient. This time limitation significantly impacts how far we can go to retrieve an organ,” said Dr. Benjamin Bryner, associate director of heart transplantation and mechanical support and director of the expanded donation program at Northwestern Medicine’s Bluhm Cardiovascular Institute, in a statement.

Over six million in the U.S. have heart failure, with an estimated 10% in need of a transplant or other advanced therapies.

OSC is the only FDA-approved technology for extracorporeal perfusion and preservation of donor hearts. It has been associated for years in the U.K. and Australia with positive outcomes, decreased wait times, and fewer patients left waiting.

Only a handful of U.S. centers perform DCD transplants. Expanding the technology would allow clinicians to travel further for organs, which would benefit hard-to-match patients and may decrease the number of unused donor hearts, which estimates put at 70%.

OSC also allows surgeons to examine the heart’s condition, assess functionality and look for injuries or damage from coronary disease in ways not possible before.

“This gives us even greater confidence in an organ’s viability for transplant and reassurance that it is going to be suitable for our patient,” said Dr. Duc Thinh Pham, director of heart transplantation and mechanical circulatory support at Bluhm Cardiovascular Institute.

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