ELIZABETH JACKSON: In a world first, Australian researchers and surgeons have successfully transplanted a heart that had stopped beating.
The donor heart was dead for 20 minutes before it was resuscitated with ground breaking preservation fluid and then transplanted.
Researchers say up to 30 per cent more lives will be saved as a result of this new technique.
It was developed by the Victor Chang Cardiac Research Institute and Sydney’s St Vincent’s Hospital.
Professor Bob Graham, the executive director of the Victor Chang Institute, led the research team. I asked him to take us through step by step how it happened.
BOB GRAHAM: In this technique, what happens is we have a patient who’s brain is almost completely gone unfortunately, sadly but they still have a little bit of brain function and so they can’t be classified as being dead.
We can however – not we, but the people looking after the patient – can inform them that there really is no hope and if the relatives agree, then we can turn off the life support and when we do that the heart gradually stops beating over about 15 minutes.
We then by law have to wait another five minutes to ensure that the heart has really stopped, then we can take the heart out and we can put it on a console where we connect it up with blood going through the heart and providing oxygen.
Gradually the heart starts to re-beat again, starts beating again, and we can keep it warm and we can transport it on this console and we also give it a preservation solution that allows it to be more resistant to the damage of lack of oxygen.
So those two things coming together almost like a perfect storm have allowed this sort of donation, this sort of transplantation of a heart that has stopped beating to occur. Before that it wasn’t possible.
ELIZABETH JACKSON: Is the preservation solution the real key here, because I understand that it can actually repair damage that the heart has suffered.
BOB GRAHAM: Look, I think both of them are important. Both the preservation solution and the console that allows the heart to be kept warm and beating and have blood going through it and getting oxygen and both of them are extremely important and I think if either had come alone, we would have a slight improvement but we wouldn’t have been able to do what we’ve done.
ELIZABETH JACKSON: And can you actually see the heart start beating again?
BOB GRAHAM: Absolutely.
ELIZABETH JACKSON: Start moving again?
BOB GRAHAM: Absolutely, you see the heart starting to beat again and if it doesn’t start beating, that’s the other nice thing about having this console and the preservation solution because we can actually see that the heart is starting to beat and has good function.
Before that if you had a procedure like this and you don’t, the surgeon doesn’t know when they put it into the recipient whether it is going to function properly. This was we already know it’s functioning well before we put it into the patient. That’s a very important feature.
ELIZABETH JACKSON: So prior to this happening, can you outline the medical protocol that you followed to transplant hearts that was still beating, because as you’ve explained, that’s what you had to do.
BOB GRAHAM: Sure, so the definition of death in this country is brain death and that means two electroencephalograms, which are a wave test that shows activity of the brain, we have two flat electroencephalograms over 24 hours apart.
So if you have that, that patient is classified as dead and then we can keep those patients on life support until we’re ready to take the heart out. The heart is beating all that time and their blood pressure is good, they get good oxygen, and then we take the heart out and we then transport it, often we just put it on ice, and we take it to the recipient and we implant it in a transplant.
ELIZABETH JACKSON: And what was the window of time?
BOB GRAHAM: The time when it is suffering is very, very short. You know, a matter of a few minutes whereas in this situation we have to wait until the heart stops and the heart stops because it’s not getting enough oxygen.
That’s the problem and during that time its getting damaged and it was not thought that it was possible to reanimate these hearts.
We have been using this, these sort of hearts, these sort of organs from a patient who is not completely brain dead where we turn off the life support from liver and kidney and pancreas and they’re more resistant to the damage of lack of oxygen in the heart but the heart was not thought to be able to be reanimated after such an insult but it turns out it is.
ELIZABETH JACKSON: So this has, obviously, huge implications for potential transplant recipients. In essence does it mean that many more hearts will now become available?
BOB GRAHAM: It means we’ll be able to do 20 to 30 per cent more transplants than we did. In addition we’ll be able to tell whether the heart is worth transplanting, because we can look at the function on the console before we transplant it. In addition we can probably match better because before we were restricted because of the time.
We can now transport these hearts over, keep them going for a longer period of time. Before, for example, we only have a four hour window generally when you’ve put the heart on ice and you can therefore can only get a heart from say Queensland to Sydney.
So now we can potentially match people across Australia and get better matching and therefore the heart will likely function better at the beginning and also long term.
So it’s a big plus. In addition it’s going to not only improve transplantation in this country but all over the world, and even further still, which I’m very excited about, there are many countries where the definition of death is not brain death but heart death.
In those countries they can’t do heart transplantation. This will potentially open up heart transplantation in counties like Japan, Vietnam and other places where the definition of death is heart death, not brain death.
ELIZABETH JACKSON: Tell me about the operations that have been performed using this technique. I understand there have been two. How are those patients going?
BOB GRAHAM: Both of the patients, I’m pleased to say, are doing extremely well. You can imagine that Peter Macdonald and Kumud Dhital, the surgeons, were on tenterhooks afterwards but the patients have done extremely well.
The first patient now is several months out after transplantation. The second one is a shorter period but the second one went like butter. It was a great operation, went very well.
The first patient, they said the heart initially looked very bad when we took it out. It gradually recovered on the console and that patient is going extremely well and has been, as I said, biopsied and the echocardiogram shows that she has normal function and there’s no evidence of damage on the histology that we took from the biopsy.
ELIZABETH JACKSON: How significant do you think it is?
BOB GRAHAM: Look, you know, there are breakthroughs you read about all the time and what you’re really reading about is the final step in thousands, a thousand long steps. This is really an important breakthrough.
There’s no doubt that this technique can be applied worldwide and can help 30 to 40 per cent of people that can’t be helped at the moment.
The number of transplants that can be done will be increased. We’re going to be able to do transplants we couldn’t do before and if you think about countries where they can’t do transplantation, we’re going to have a big impact.
This is not a minor breakthrough. This is something that’s here today. It doesn’t have to wait. It’s already being done.
ELIZABETH JACKSON: And that’s Professor Bob Graham, the executive director of the Victor Chang Institute, and a longer version of that interview will be available on our website.
source:abc.net.au
STUDIO 3 NEWCASTLE AUSTRALIA 