Extending Reach, Improving Outcomes: The Future of Transplant Surgery
A Cincinnati Children’s Heart Institute transplant patient thought he might have to wait at least a year for a donor organ. Thanks to new technology in use at the medical center, he received a new heart in just weeks.
In January, Cincinnati Children’s became among the first pediatric hospitals to use the Organ Care System (OCS) Heart System from TransMedics, Inc. This product, nicknamed “heart in a box,” keeps a donor heart warm and beating while the surgical team prepares for transplantation. It’s a giant leap from the standard method of keeping a heart arrested on ice in a cooler during transport.
The FDA-approved OCS Heart System allows users to resuscitate a heart after removal from the donor by putting it into a portable box that supplies it with oxygen and nutrients and keeps it pumping until time for transplant. The system also allows for the heart’s function to be assessed up to the time of implantation.
A Donor Heart in Under a Month
Adam Bowen was born with a congenital heart condition and is cared for through the Heart Institute’s Adult Congenital Heart Disease Program. At age 38, he needed a new heart. He expected to be on the donor wait list for about a year or more. Instead, thanks to the OCS Heart System, he waited less than a month.
“We got the heart from somewhere more than twice as far as we previously would have been able to go,” says David L.S. Morales, MD, executive co-director of the Heart Institute and director of Cardiothoracic Surgery at Cincinnati Children’s. “This system has increased our donor field tremendously.”
Using this new technology means that organs can come from more donors and farther distances, because transport time is now able to be lengthened. With traditionally putting a heart on ice for transportation, four hours is roughly the maximum acceptable cold ischemic time—the amount of time the heart is cold and not receiving a blood supply. Using the OCS Heart System, that out-of-body time can be more than doubled.
More Transplants, Fewer Unused Organs
Morales believes this technology will lead to an increase in the number of transplants, as well as a decrease in the number of unused organs. The team is now able to list certain patients in need of transplant at 3,000 nautical miles. That means a patient on the U.S. east coast could potentially get a heart from as far away as California, Canada, or even Anchorage, Alaska.
Morales emphasizes that many of their programs’ patients can have longer ischemic times because the majority are congenital heart surgery patients that have had multiple palliations in the past. Surgeons face this challenge in transplants for patients who need significant reconstruction due to complex situations such as isomerism, dextrocardia, and hypoplastic left heart syndrome. Many of these patients have undergone multiple heart operations, even up to eight past procedures. The team has now used the OCS Heart System for a patient with a Fontan circulation.
“Ischemic time has always been strongly associated with poorer long-term outcomes,” Morales says. “Previously, ischemic time for a Fontan transplant needing arch and pulmonary artery work would have been four hours or more. Now it can be done with 90 minutes to two hours of ischemia.”
Two hours used to be considered a very short ischemic time during transplants and rarely achieved because of travel. Now, the team can achieve their shortest ischemic times in cases with either the farthest donors or the most complex patients.
Changing the Field of Pediatric Heart Transplant
The OCS Heart System isn’t appropriate for every heart transplant, and it may be cost-prohibitive for some hospital systems. But Morales cites the many costly factors that the system can help avoid, including a patient’s extended time in the ICU waiting for a heart, and missed time from school or work. From an overall “big picture” perspective, he feels strongly it’s cost effective.
Acquiring this new technology coincides with the mission of Cincinnati Children’s to continuously find ways to improve child health.
“We are committed to leading the field and showing how we can change outcomes for our patients,” Morales says. “Part of how we do that is with new technology. This system has changed the field of adult cardiac transplant, and I feel that it can change our field of pediatric and adult congenital heart transplantation as well.”
(Published April 2023)
