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Clinical Updates
UCLA testing new system for transporting donor hearts to improve organ availability
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UCLA is one of five heart transplant centers in the nation — and the only one on the West Coast — testing the efficacy of the Organ Care System, which uses groundbreaking technology to keep donor hearts warm and beating outside the body until transplantation. Also known as “heart in a box,” the system offers significant improvements over the cold storage method currently used to transport donor hearts and could significantly increase the number of donor hearts available for transplantation.
Organ Care System uses advanced technology
The Organ Care System is a portable platform that uses wireless monitors, proprietary preservation solutions and a perfusion module to keep warm, oxygenated blood pumping through the heart. The system consists of three components:
A portable console that houses an oxygen supply and a pump to maintain blood flow to the organ. The battery-operated system has wireless controls and a monitor that allows physicians to assess the health of the donor heart, including aortic pressure, coronary flow, blood temperature and heart rate.
A perfusion module, which is a sterile, transparent chamber that is designed to protect the heart and to maintain its temperature and humidity. The module, which gives the system its “heart in a box” nickname, allows physicians to take blood samples and to conduct ultrasound assessments of the organ.
Proprietary solutions to help maintain organ viability. These fluids, containing nutrients and other compounds, are pumped through the donor heart to help maintain its function until transplantation.
Living organ transport offers many advantages over cold storage
Cold storage, in which donor hearts are literally placed on ice, has been the standard for transporting donor hearts for more than 25 years. While cold storage was conceived to reduce metabolic demands and slow the rate of organ cell death, donor hearts rapidly deteriorate. Unlike kidneys and other organs, hearts stored at 4 degrees centigrade typically survive only six to eight hours before they suffer too much ischemic injury to be used in a transplant.
The narrow window of viability restricts the geographic distance a donor heart can travel and contributes to the shortage of donor hearts. Currently, about 3,000 people await a new heart, while around 2,000 heart transplants are performed annually. (The number of heart transplants dropped from a high of 2,363 in 1995 to 2,211 in 2009; experts attribute the decline to the many lives saved by seatbelt and motorcycle helmet laws.) There would be more donor hearts to meet demand if not for the rapid deterioration of hearts transported using cold storage. And donor hearts stored on ice have other limitations: surgeons cannot evaluate the health of the heart or conduct extensive HLA matching tests until after transplantation.
The Organ Care System, which keeps nutrient-rich and oxygenated blood pumping through the donor heart, appears to solve many of the problems associated with cold storage. Donor hearts maintained in a functioning state at 34 degrees centigrade appear to withstand longer periods of time outside the body without suffering ischemic injury, perhaps as long as 24 hours. Because the donor heart is beating when it arrives, surgeons can assess the organ’s health. Surgeons may even be able to repair and improve the function of some donor hearts before transplantation, which not only improves outcomes but would also make more donor hearts available for transplant.
UCLA Heart Transplant team has extensive experience with the device
Although the Organ Care System has been tested successfully in Europe, UCLA is one of only five heart transplant centers in the United States approved to test the ground-breaking device. UCLA has more experience with it than any other transplant center in the nation, enrolling nearly half of the 13 patients who participated in Phase 1 safety trials.
UCLA patients also have an opportunity to participate in Phase 2 efficacy trials, which will enroll 128 patients.
“It’s the mission of UCLA to be at the forefront of the most innovative technology in heart transplantation,” says Abbas Ardehali, M.D., William E. Connor Professor of Surgery and director of the Heart, Lung and Heart-Lung Transplant Programs, who serves as principal investigator for the U.S. trial.
“I’m delighted to play a leadership role in this important study and offer our patients this breakthrough technology,” adds Richard J. Shemin, M.D., professor and chief, UCLA Division of Cardiothoracic Surgery.
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