Hold on to your lunches, we’re about to get Reanimator up in here.A Massachusetts-based company called Transmedics has created a “heart-in-a-box” that pumps oxygenated blood and electrolytes into hearts from recently deceased patients, allowing the organs to continue functioning within a chamber. The system has been successfully deployed in at least 15 heart transplants in the UK and Australia, and is awaiting regulatory approval in the US.
Although it could increase the pool of donated hearts by 15-30%, there are still some issues with it. A need for greater automation and a reduction in the $250,000 cost are practical issues that can be overcome, but the bioethical ones are more slippery.Currently hearts used for transplants have usually been extracted from brain-dead patients; those from dead patients have been considered too damaged. The problem is that there are not nearly enough brain-dead donors. The crisis is particularly severe here in the U.K., where the prohibition on firearms has meant that there are more than twice as many heart donors per capita in the U.S. as in the U.K., (probably the most horrendous accidental argument for loosened gun control).Taking hearts from circulatory-death donors could expand the supply in the U.K. by almost a third, or an additional 50 hearts on top of the 180 a year available now.The tricky question is how long surgeons should wait before removing a heart that has stopped – if circulatory function is restored in a different body, can you really say that circulatory death is ‘irreversible’?The basic answer is that you draw a line based on experience, best practice and consultation with families. In the U.S., the accepted standard is five minutes, although Colorado surgeons in 2008 took hearts from brain-damaged newborns after waiting only 75 seconds.For all the issues, warm transplant transport seems to be future, over the current cold temperature approach. With the continual need for transplantable organs, any improvements can only be a good thing: