2025 HFSA Contemporary Issues in Heart Failure - OnDemand-Expanding Heart Transplantation

Video Transcription

Video Summary

Dr. Ben Briner, a cardiac surgeon at Northwestern, discusses advances in donor heart preservation amidst growing demand for quality donor hearts. Initially, heart transplants were limited by medical and logistical challenges, but immunosuppressive drugs and diagnostics have improved outcomes. Traditionally, donor hearts were transported in ice-filled coolers at about 4°C, limiting safe transport times to under four hours. Newer cooling devices like the Paragonix SherpaPak maintain consistent temperatures above freezing, reducing heart muscle damage during transit and lowering severe primary graft dysfunction (PGD).<br /><br />Machine perfusion technology, such as the TransMedics Organ Care System (OCS), perfuses the heart with oxygenated, warm blood, keeping it beating and viable for up to eight hours, enabling longer-distance transport and better assessment of organ function. This system has expanded donor availability and includes use of hearts from donation after circulatory death (DCD), a previously underutilized source. Normothermic regional perfusion (NRP) restores blood flow regionally after cardiac death, allowing evaluation before transplantation. Another emerging device, the Ex-Vivo heart box, offers cold oxygenated perfusion without re-warming the heart, extending preservation times.<br /><br />Choosing preservation methods depends on donor type (brain death vs. circulatory death), distance, and logistical factors. Integration of these technologies aims to increase usable donor hearts, improve matching, reduce wait times, and potentially enhance long-term transplant outcomes, although more research is needed to understand preservation's impact on rejection and survival.

Keywords

donor heart preservation

heart transplant advances

machine perfusion technology

Paragonix SherpaPak

TransMedics Organ Care System

donation after circulatory death (DCD)

normothermic regional perfusion (NRP)