09 July 2014
Harefield Hospital has become the first transplant centre in the UK to adopt a revolutionary system that enables a donor heart to beat outside the human body before it is transplanted.
In 2013-14, Harefield Hospital carried out 26 heart transplant operations and, in all but one case, the patient received an organ that had been transported and prepared for transplantation using the groundbreaking ‘beating heart’ technology.
The Organ Care System (OCS™), also known as "heart in a box", simulates the conditions of the human body, pumping oxygenated blood inside the heart so it can continue to function as it would in a living person.
The innovative system, developed by US company TransMedics®, replaces the traditional "cold ischemia" (ice preservation) method of transporting the heart, increasing the time the organ can be maintained outside the body to at least eight hours, compared with a maximum of three to four hours on ice.
This means hearts can be retrieved from further afield and transported to Harefield. It also safely preserves the donor heart in the case of a more complex transplant operation, which takes longer to prepare the recipient to be ready to accept the new heart.
Royal Brompton & Harefield NHS Foundation Trust began using the technology in February 2013 because of the number of organs that surgeons were forced to decline due to distance (for example, Scotland and the Republic of Ireland) and apparent organ quality when matched to the characteristics of some recipients.
The retrieval team has since been able to accept ‘marginal’ organs – which might usually have been deemed too risky for the recipient – after the retrieval surgeon was able to assess the ‘functioning’ heart to consider whether it was suitable for transplantation.
Equally, using the OCS has meant the retrieval surgeon could identify hearts which performed badly, despite initially appearing suitable for transplantation from standard diagnostic tests. This has prevented patients from receiving a donor heart that will not work.
In addition to helping increase the total number of transplant procedures carried out at Harefield Hospital, the OCS has proved to be invaluable for patients who, like Andrew, have a Ventricular Assist Device (VAD) – sometimes known as an ‘artificial heart’ – keeping them alive as a ‘bridge to transplant’.
In the four year period between January 2010 and December 2013 there were 271 long term devices implanted into adult patients across the whole of the UK. However, only 47 patients with these devices received a heart transplant in the same period – an average of less than 12 per year nationwide.
Since the Trust began using the OCS in February 2013, Harefield Hospital alone has been able to transplant 17 VAD patients (until end of June 2014), compared with just seven patients in the previous three years combined (2010-2012).
Mr André Simon, consultant surgeon and director of transplantation, said:
“This new technology has enabled us to increase the organ offer-to-transplant conversion rate. Put simply, it means that patients at Harefield have had life-saving heart transplants which otherwise would not have been possible – primarily because we have travelled greater distances to retrieve an organ and have been able to transplant many more patients who already have an implanted device keeping them alive.
“Harefield has the largest number of patients with VADs in the UK and transplantation in these circumstances is particularly complex. It requires greater skill and time to safely remove the device and prepare the chest cavity to receive the donor heart. The OCS allows our surgeons precious surgical time and means that more of these patients are having transplant procedures.
“For us the OCS technology has become the gold standard for organ retrieval. It means we can transplant more patients and has resulted in patients spending less time on intensive care and in hospital post transplant compared with previous years. We have also reduced the incidence of post-transplant heart failure.”