The waiting lists for a donor heart will probably go down in the future. Thanks to a new technique developed by UCMG, UMC Utrecht and Erasmus MC: the heart-in-a-box. As a result, about 30 additional heart donations can be made each year.
The new technique offers hope for waiting heart patients. “Heart transplants are increasingly becoming a routine operation, says heart-lung surgeon Michiel Erasmus of the UMCG. “At first, these types of operations often took place at night, but because the heart on the machine can remain outside the body for a few hours, this is now also possible in the morning. Of course you prefer to have a fresh team that starts during the day. This benefits the patient and the quality of the transplant.”
Since the introduction of this technique in 2021, more than 60 hearts have already been transplanted in the Netherlands using the heart-in-a-box technique. 30 of those have occurred in 2023 so far. “While this used to be our annual average,” says Erasmus.
In the Netherlands, 164 people were on the waiting list for a donor heart at the end of July, in Groningen there are currently 47. “We see that heart transplants are really increasing and the waiting list is decreasing.”
This is how the heart-in-a-box works
With DCD heart donation (Death after Circulatory Death), the heart of a deceased donor patient is placed in a so-called perfusion machine. After the supply of blood and oxygen, this can beat again, up to a maximum of eight hours. Previously, only a heart from a brain-dead donor could be used.
The video below shows how a donor heart keeps beating on the machine:
“The heart can be on the machine for a maximum of eight hours, but we keep it on for three to six hours,” says Erasmus. “With this machine, the quality of the heart does not deteriorate, because the heart does not lack oxygen. The donor is often in a different hospital than the heart patient. This time savings means that the patient can be helped.”
The UMCG, UMC Utrecht and Erasmus MC Rotterdam now have two machines together. “But probably every center will get a device.”
Other organs
The perfusion machine has been used for some time for lungs, livers and kidneys. Lungs – unlike the heart – can be kept outside the body without a machine, because they are inflated after being removed from the body. As a result, they retain their oxygen supply. These machines have already been further developed. “We can measure the quality of the donor organ for the liver and lung.”
This is not yet possible for the heart; to measure the quality, the grip force must be determined. The current machine is not yet capable of this. The UMCG, Erasmus MC Rotterdam and UMC Utrecht are conducting research to develop this, so that even more hearts can be transplanted in the future. “But a doubling of the number of heart operations is the limit for the time being,” says heart surgeon Erasmus.