Medical City Heart Hospital is the first in the state to complete a complex heart transplant procedure that could increase the number of eligible heart donors by 30%. Called donation after cardiac death (DCD) involves surgeons quickly accessing the heart and bringing it back to life after the life support has been removed.
Heart transplants are never simple tasks and are usually limited to patients who die of brain death when all the organs are still functioning, but the brain is no longer functioning. The patient is legally determined to be brain dead and is taken to the operating room, where the heart can be stopped in a controlled situation before him, and other organs are removed for transplantation.
In DCD, the patient often suffered devastating brain injury but was not officially declared brain dead. At this point, the patient is no longer supported and he experiences cardiac death, which means the heart has stopped. While organ harvesting after cardiac death has long been done with other organs, the heart is a different animal. After the life support has been removed from the patient, providers must wait five minutes after the patient is pronounced dead, and then can begin the procedure, but they must work quickly. Every passing moment that the heart is not working reduces the chances that it will be used in a transplant.
Once the body cavity is opened, surgeons must quickly reach the heart before resuscitating it in the patient’s chest. Then, with a heart-lung machine used in heart surgeries, surgeons bring the heart back to life and pump blood through it to make sure it comes back to life. During this first surgery, it took 45 minutes to confirm that the heart was fully functional. At this point, it was removed and successfully transplanted into the recipient.
While it typically takes surgeons about 20 minutes to reach the heart during a routine organ donation operation, DCD requires a much faster operation. For the first surgery, Dr Brian Lima and his team placed the heart on the heart-lung machine in just seven minutes. Lima is the surgical director of heart transplantation and mechanical circulatory support at Medical City Heart Hospital. âYou’re talking about something that is out of the norm for what we typically do as cardiac surgeons, so it’s something that you need to be comfortable and confident about,â he says. âFew teams would be ready to do it. take that kind of risk.
The recipient of that first DCD transplant was Yolanda Triplett, 50, who has been on the transplant list since 2014 after breast cancer treatments damaged her heart. One day after the transplant, she was standing and moving, feeling the strongest she had felt in years. âWhen I found out I was going to have a new heart, I was both excited and nervous because I had been waiting for this for so long,â Yolanda Triplett said via release. “I thought it would never come and when it did it hit me all of a sudden, and I’m so grateful for this wonderful gift.”
The Medical City team has performed 600 heart transplants since 1991 and is consistently ranked among the top performing centers in the country. The ability to perform DCD heart transplants has generated interest across the country as so few teams perform the surgery. The team can travel up to 750 miles to perform DCD surgery and already has inquiries from as far as Alabama. In the UK, this procedure has increased the number of heart transplants by 30 percent. People whose support has been withdrawn and who were previously only eligible for other organ donation can donate their hearts.
“We are willing and keen to be very supportive of this program so that we can reach as many patients as possible,” said Andrea Daniels, director of operations at Medical City Heart Hospital. “The idea is to minimize the wait time and get the patients transplanted as soon as possible.”
While the surgery requires a massive lift to transport the team and equipment, sometimes hundreds of miles, it tackles a life and death issue for families. âIt’s limited by the scarcity of donor hearts. There are hundreds of people who die every year waiting to be put on the list, âsays Lima. The United States only does about 3,000 heart transplants per year, so every additional donor is a massive win.
âThe hope is that it becomes mainstream,â Daniels says. âWe are really fortunate to have enough willing and talented surgeons and team to do this. “