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Physicians Update

 
Summer 2010

New Organ-Preservation System May Increase Donor Pool, Improve Outcomes

07/14/2010
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PU-Summer2010-Preservation SystemSince the advent of transplantation, the only method to preserve a donor heart has been to place it in a cold preservation solution during transport to the recipient. But that may change with a new heart-preservation system now in a multicenter clinical trial. The new system is designed to maintain the heart in a warm, beating and functioning physiologic state outside of the body.

“Human hearts were never meant to be put on ice in a cooler,” says cardiothoracic surgeon Abbas Ardehali, M.D., surgical director of the UCLA Heart and Lung Transplant Program and principal investigator of the Organ Care System trial in the U.S., which is being conducted at UCLA — the only location in Los Angeles — and four other leading heart-transplant centers across the country.

Many major transplant centers, including UCLA, only consider using donor hearts that can be transplanted within six hours or less of recovery. Using a new organ-preservation system in which the heart is revived to a beating state, protected within a sterile chamber and continuously perfused with warm, oxygenated, nutrient-rich donor blood, the heart may potentially be kept outside of the body for longer periods of time, with less vulnerability to damage during transport to the recipient.

“If we’re able to safely transport donor hearts across longer distances, from the East Coast to the West Coast, for example, we may be able to increase the pool of donor hearts available to patients, which improves the likelihood of an optimal match between donor and recipient,” Dr. Ardehali says. Currently, heart donors and transplant recipients are matched based on blood type, size of the heart, medical urgency of the patient, time on the waiting list and distance between donor and recipient. Tissue matching typically occurs after heart transplantation due to time constraints, but if the target window of time from recovery to implantation is extended beyond six hours, pre-transplant tissue matching may be possible.

Another potential benefit of the new system, Dr. Ardehali says, is the ability to more comprehensively assess the heart prior to PU-Summer2010-TransMedicsimplantation using imaging, as well as functional and metabolic testing. This may lead to improved immediate and long-term heart function, reduce the risk of organ rejection and increase the number of hearts accepted for transplant.

“A lot of donor hearts are currently discarded,” says cardiologist Ann Hickey, M.D., medical director of the UCLA Heart Transplant Program. “If we have the time and the technology to get a better look at the heart prior to transplantation, we may find that we can use some of the donor hearts that would have otherwise been rejected.” In addition, Dr. Hickey says new techniques are being developed that will allow physicians to improve the function of donor hearts prior to transplantation, which may also help to increase the available donor pool.

“This is a new era in heart transplantation,” Dr. Hickey says. “Together, these technologies have the potential to significantly reduce the number of patients who die while waiting for heart transplantation and improve long-term outcomes for heart-transplant recipients.”





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