Proposed Topic (Most preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Authors (including presenting author) :
Lee OJ (1), Bhatia I (1), Wan HY (1), Fan YY (2), Wong KL (2), Au WK (1), Ho KL (1)
Affiliation :
(1) Department of Cardiothoracic Surgery, Room 308, New Clinical Building, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR.
(2) Cardiac Medicine Unit, 5/F Kwok Tak Seng Heart Center, Grantham Hospital, Wong Chuk Hang, Hong Kong SAR.
Introduction :
The shortage of organs for heart transplantation (HT) has created a need to explore the use of extended-criteria organs. These extended-criteria or marginal donor hearts are declined as they do not meet one or more of the criteria under conventional transplant guidelines for an optimal heart donor. We report the preliminary use of normothermic TransMedics Organ Care System (OCS) Heart system- an ex vivo approach- to preserve extended-criteria brain-dead (BD) donor hearts. The OCS maintains the donor heart at normal temperature, and provides continuous perfusion and oxygenation, reducing the ischemic time and enabling additional viability assessment options.
Objectives :
We report the preliminary use of normothermic TransMedics Organ Care System (OCS) Heart system- an ex vivo approach- to preserve extended-criteria brain-dead (BD) donor hearts.
Methodology :
In a retrospective single-centre study conducted from April 2020 to March 2023, four marginal donor hearts with extended criteria were procured from BD donors and monitored using the OCS. Suitability for transplantation was assessed based on stable or decreasing lactate levels, along with appropriate perfusion parameters.
Result & Outcome :
The indications for use of the OCS were coronary artery disease, left ventricular hypertrophy, donor on high dose inotropes, a downtime of > 20 minutes and a left ventricular ejection fraction (LVEF) of 40%-50%. Three of the four donor hearts were transplanted, and one was discarded due to rising lactate concentration. The three recipients had a higher surgical risk profile for HT. All showed normal cardiac function and no primary graft dysfunction postoperatively. At 2-3 years post-HT, all recipients have LVEF of >60% with only one showing evidence of mild rejection.
OCS enabled the successful transplantation of marginal donor organs in high-risk recipients, yielding excellent outcomes, showcasing the feasibility of recruiting donors with extended criteria. It is a safe and promising technique to expand the donor pool and address the organ shortage in HT in Hong Kong.
