Heart in a box

by YankeeJim | December 5, 2010 at 01:45 pm

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Got a live one. Here’s a macabre story, though a life saver.

I always thought it was weird to see Styrofoam ice chests sitting outside a surgery room, or being carried around a hospital. I suspected often the contents are donor organs on their way to a waiting patient.

They can’t get there too soon because the longer the wait, the more they deteriorate.

Now, someone has invented a way to keep a heart pumping and warm right up until surgery. No need to put it on ice. Keeping it alive is a preferred option with all sorts of benefits.

“Warm, beating hearts offer new hope for transplants

Doctors testing experimental technique that eliminates mad rush to ship organs

By ALICIA CHANG

Associated Press

LOS ANGELES — Andrea Ybarra's donated heart was beating rhythmically by the time she awoke from the grogginess of her surgery.

Lub-dub. Lub-dub. Lub-dub. In fact, it was warm and pumping even before doctors transplanted it.

Ybarra belongs to a small group of people who have had a "beating heart" transplant, an experimental operation that's mostly been done in Europe. The donor heart is placed into a special box that feeds it blood and keeps it warm and ticking outside the body.

"I felt peaceful when I woke up. I wasn't scared," recalled the 40-year-old from Los Angeles who suffers from lupus. "It felt like the heart was a part of me all the time."

Despite advances in heart transplantation, the way hearts are moved around the United States and most places remains low-tech.

A team of doctors and organ recovery specialists stuffs an off-the-shelf picnic cooler with ice and jets off at odd hours to a donor hospital where a heart from a brain-dead patient awaits. They inject a chemical to stop the organ and preserve it in the ice chest for the trip home.

Once a heart is harvested, it's a race against time. A heart can stay fresh in the cooler for 4 to 6 hours before it starts to deteriorate. Because of this constraint, doctors can't travel too far to heart-hunt.

It's been done this way for more than four decades, ever since the first U.S. heart transplant was performed on Dec. 6, 1967.

Delays can mean death or disease
Research has shown that the longer it takes to remove a heart and transplant it, the greater the patient's chance of death or heart disease.

But what if a heart could beat on its own after removal from a cadaver?

It may sound a bit macabre, more like an Edgar Allan Poe story. The new high-tech heart box circulates blood from the donor to the heart so that it continues throbbing while in transit from hospital to hospital.

Based on some success overseas, the University of California, Los Angeles is currently heading an experiment along with several other schools that compares the safety and effectiveness of the new preservation method versus the standard cooler.

If the new technology succeeds in preserving hearts longer, it could change the field, experts say.

No longer will patients be limited by location. Doctors could make cross-country heart runs without worrying about how long it takes. Hearts are now given first to people on the waiting list who live near where the donor is hospitalized. If there's no match, then the circle widens until a recipient is found.

"The rush factor will be taken out. I can go all the way to the West Coast to get a heart," said Dr. Bruce Rosengard of Massachusetts General Hospital, who performed the first beating heart transplant in the United Kingdom in 2006.

It may also potentially help ease the organ shortage crisis. Some 3,000 Americans are currently on the heart transplant waiting list. Last year, 359 died waiting for a heart — almost one person a day.

The thinking is that hearts may be in better condition if they're kept beating instead of being cooled in ice. And if hearts can be monitored outside the body, proponents say this may help increase the organ pool by allowing less-than-perfect hearts to be transplanted.

When a heart becomes available
Ybarra's surgery began like any other. The call came in to Ronald Reagan UCLA Medical Center shortly before 4 p.m. on Aug. 24. There is a heart available. Do you have a match?

The transplant team dialed Ybarra. Her lupus, an immune system disease in which the body attacks its own organs, had ravaged her heart, leaving it enlarged and weak. She desperately needed a transplant.

The following day, a brigade of doctors and technicians set off before dawn by limo to the Van Nuys Airport to board a private jet to the donor hospital in the Palm Springs area east of Los Angeles.

Since Ybarra signed up to be part of the beating heart experiment, she had a 50-50 chance of having the new operation.”