2023-06-14 18:56:19
MONTREAL — A technological innovation that might make its way to Canada in the coming months might increase the number of hearts available for transplant.
A clinical study recently demonstrated the effectiveness of the “Organ Care System” technology developed by the American firm TransMedics. This technology allows doctors to “resuscitate” the heart of a donor who is in cardiovascular death and to test its functioning before the transplant.
In the clinical trial, 94% of the 80 patients who received a resuscitated heart were still alive six months following the transplant, compared to 90% of the 86 patients who received a heart from a neurologically dead donor.
“The results at one year are really excellent, they are as good, if not better, than the neurological deaths, noted the medical director of the heart transplant program at the Montreal Heart Institute, Dr. Normand Racine. It shortens the waiting time for patients.”
In addition, he adds, regarding 90% of the cores placed in the device might then be used, “so the yield is excellent”. He points out, however, that the participants in the study had been carefully chosen, for example by only appealing to individuals aged 49 and under.
In the United States, said Dr. Racine, the use of this new technology has increased the number of available donors by 5%, “so it’s still a lot (…) and then eventually I think it’s going to be more than That”.
A patient is considered cardiovascular dead when their heart has stopped beating for at least five minutes, even if minimal brain activity persists. Conversely, a patient who is neurologically dead no longer has any brain activity, but his organs continue to function with the help of machines.
It is frequently the organs of donors who are neurologically dead that are removed for transplant purposes, with the consent of the patient’s family and in compliance with the wishes expressed by the latter before his death.
In some countries, organs are also removed from donors who have died from cardiovascular disease, but of all the organs available, the heart is the one that tolerates the interruption of circulation the least well.
It is this obstacle that the new technology aims to overcome by resupplying the heart with oxygenated blood and checking its functioning before a transplant.
In Quebec, it is possible, in certain circumstances, to remove organs for transplant purposes in the absence of a diagnosis of neurological death. A medical protocol is gradually being deployed in several hospitals to collect kidneys and recently liver lobes and lungs, we can read on the Transplant Quebec website.
The Transplant Quebec ethics committee has been studying the file of donations following a cardiovascular death for nearly two years, said Dr. Racine.
“They had a lot of questions, they want to make sure it’s done to the strict standards, obviously,” he said. We think that probably within 6 to 8 months, the file will be officially accepted by Transplant Quebec.”
It also remains to be seen whether the cost will represent an obstacle. The TransMedics device alone costs regarding US$300,000. Each use requires a US$75,000 infusion set… with no guarantee that the heart placed in the device can then be transplanted.
The findings of this study were published by the prestigious New England Journal of Medicine.
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