Recent innovations in the US are opening new possibilities for donor availability.
Leading institutions, Duke Health and Vanderbilt University Medical Centre, have developed techniques to increase the donor pool and enhance organ recovery processes.
Duke Health has pioneered a world-first technique that could expand the donor pool for paediatric heart transplants in the US by up to 20%.
Meanwhile, researchers at Vanderbilt University Medical Centre have also created a new method for recovering hearts from deceased organ donors after circulatory death (DCD).
The New England Journal of Medicine details both ground-breaking approaches.
The first paper examines Duke Health’s efforts to overcome barriers to heart donation after DCD in infants.
Joseph Turek, senior author of the study and chief of paediatric cardiac surgery at Duke Health, said: ‘This innovation was born out of necessity. We were determined to find a way to help the smallest and sickest children who previously had no access to DCD heart donation.’
DCD is a technique that allows heart donation to take place after circulatory death, rather than brain death (the standard in donation), as long as the heart’s functionality can be assessed on a perfusion device.
It has been used in adult and adolescent transplants, but existing perfusion devices are too large to fit infant hearts.
A technique called normothermic regional perfusion (NRP) could reanimate the heart inside the body, but it carries logistical and ethical barriers – leading many centres to avoid using it. The lack of NRP uptake results in viable paediatric donor hearts going unused.
To overcome this, the Duke team developed a novel technique that temporarily reanimates the donor heart outside the body, on a surgical table using a heart-lung machine (extracorporeal membrane oxygenation, or ECMO), allowing surgeons to assess the organ’s viability before transplant.
The approach avoids the barriers associated with NRP and could become a new standard of care.
Duke scientists are calling the new technique on-table heart reanimation. The first-of-its-kind case saved the life of a then three-month-old patient, who received the procedure earlier this year.
Turek estimates the new on-table heart reanimation technique has the potential to save as many young lives as there are viable paediatric donor hearts currently going unused.
He added: ‘This is a major step forward in paediatric transplant medicine. On-table heart reanimation could dramatically expand the availability of precious donations transforming loss into life with greater stewardship and hope.’
Meanwhile, Vanderbilt University Medical Centre’s method – rapid recovery with extended ultra-oxygenated preservation (REUP) – involves flushing the donor heart with a cold oxygenated preservation solution after death.
This also avoids the ethical concerns associated with NRP.
In an article published in the New England Journal of Medicine, first author Aaron Williams suggested the technique has great potential to expand the number of donor hearts available by making organ preservation technology more widely accessible worldwide and increasing the use of DCD hearts.
He said: ‘It’s something that has never been done in the field of heart transplantation with success. I think this is really going to be a game change-. This is going to be a technique that’s going to essentially have worldwide applicability.’
The VUMC team successfully deployed the method in donor hearts used in three transplants, starting in November 2024. The technique involves the use of a flush circuit to oxygenate two litres of cold preservation solution, which includes packed red cells, Del Nido cardioplegia, and other additives.
To date, VUMC has used the method for 20 transplants with ‘excellent outcomes’.
Williams said the technique has been successful in preserving hearts for more than four hours and up to eight hours.
He added that the new technique described in the paper has only been used on donor hearts, and further study is needed to see if it can be applied to other donor organs, such as livers, kidneys, pancreas and lungs.
It too can be applied to paediatric transplants.
