The NYU Langone Transplant Institute on Monday became the first center in the United States to transplant a heart using a novel method in which, after the heart has stopped beating and death has been declared, surgeons place the organ donor on cardiopulmonary bypass and blood is circulated through the body.
This enables transplant surgeons to assess a heart for transplant while mitigating potential injury to all organs. It also holds the promise of significantly increasing the number of heart transplants from donors who have died from cardiac arrest as opposed to the typical donation after brain death.
The procedure was performed by a team of cardiothoracic surgeons, anesthesiologists, intensivists, nurses, perfusionists, and others from the Transplant Institute, in collaboration with LiveOnNY, the organ procurement organization. It is the first in an ongoing research study to evaluate the feasibility and safety of the protocol.
“This groundbreaking transplant procedure is the culmination of nearly two years of hard work to ensure all the ethical, logistical, and regulatory needs and requirements were met,” says Nader Moazami, MD, professor in the Department of Cardiothoracic Surgery and surgical director of heart transplantation and mechanical circulatory support at NYU Langone.
Other transplant centers in the country have recently launched clinical trials to study donation after circulatory death, or DCD, using a device which circulates warm, oxygenated blood through the heart after it has been removed from the body. NYU Langone’s innovative protocol uses the standard cardiopulmonary bypass used in cardiac surgery to reestablish circulation while the heart is still in the body.
“We’re thrilled with the success of this first transplant surgery, which has promise to increase not only heart donation rates, but other lifesaving organs as well,” says Zachary N. Kon, MD, associate professor of cardiothoracic surgery and surgical director of lung transplantation at NYU Langone. “One of the advantages of this novel method is that it gives all organs the potential benefit of restoring perfusion prior to procurement.”
While transplant centers across the country have made great strides to address organ shortages, the demand still far exceeds the supply. According to the Organ Procurement and Transplantation Network, there were 3,399 heart transplants in 2018, with 3,800 patients remaining on the wait list, resulting in 314 deaths and 330 becoming too sick for transplantation.
Most heart donations in the United States are from patients who are declared brain dead; experts hypothesize that the widespread dissemination of controlled DCD could increase the donor pool by as much as 20 percent.
NYU Langone developed the new protocol in collaboration with LiveOnNY.
“This quantum leap forward in American transplantation is a game changer for those desperately awaiting heart transplants by expanding the pool of suitable donors,” says Amy L. Friedman, MD, executive vice president and chief medical officer at LiveOnNY, which helped NYU Langone identify the organ donor. “It resulted from the generosity and commitment of this one donor and their loved ones who honored the donor’s wish to save the lives of others.”
Dr. Kon and Dr. Moazami are co-authors on an article published January 8 in the American Journal of Transplantation, investigating the ethical and logistical concerns for establishing controlled DCD heart transplantation in the United States. They collaborated with colleagues in NYU Langone’s Division of Medical Ethics, Brendan Parent, JD, adjunct instructor in the Department of Population Health, and Arthur L. Caplan, PhD, the Drs. William F. and Virginia Connolly Mitty Professor of Bioethics in the Department of Population Health, among others.
“The NYU Langone Transplant Institute is constantly seeking to drive discovery and innovation in the field of transplantation, to help all those waiting for a lifesaving organ,” says Robert Montgomery, MD, professor of surgery and director of the Transplant Institute. “This is an exciting advancement that will likely have a major impact on transplantation rates in this country.”