Symposium Takes a Hard Look at Heart Transplantation Protocols

Heart transplantation is in flux. As donor pools grow smaller, the medical community is looking for nontraditional ways to procure hearts for life-saving transplantations.

Advanced Therapies for End-Stage Cardiopulmonary Disease

Tuesday

1:00 p.m. – 3:00 p.m.

Room 30E

“The reality is that there are significant unknowns in thoracic organ transplantation, and significant change is under way,” said Jonathan W. Haft, MD, of the University of Michigan in Ann Arbor, who will co-moderate today’s session on Advanced Therapies for End-Stage Cardiopulmonary Disease.

One of the session’s key presentations will outline the first planned clinical trial for implanting hearts from donors who suffered cardiac death, rather than the typical approach of procuring organs from patients who suffered brain death. Improving success in preventing patients from progressing to brain death is steadily reducing the pool of hearts and other organs available for transplantation.

Kidneys have long been donated following cardiac death, as have growing numbers of livers, lungs, and other organs—but rarely hearts, at least not in the United States.

“We don’t know if a heart that has progressed to cardiac death is permanently injured and would potentially function in the recipient,” Dr. Haft said. “In a variety of scenarios, these hearts can be reanimated and assessed for suitability for transplantation, and this has been performed with some frequency overseas. It is thought that procuring hearts after cardiac death could increase potential heart donors by 25%.”

There also are new financial models for organ procurement and preservation that could transform clinical practice. Organ procurement teams typically fly to donors, who are most often in community hospitals. After procurement, organs are transported to centers for transplantation.

One of the newest procurement models involves transporting donors to standalone procurement centers that include surgical centers.

This practice has significant financial and clinical potential, Dr. Haft said. Under the current system, organ procurement teams descend on community hospitals that do not often deal with organ procurement and are not familiar with best practices.

“If you can move procurement to surgical centers that do this day after day, it might be more effective and reduce costs,” he said.

Organ allocation is another key area of interest. The Organ Procurement and Transportation Network changed adult heart allocation policies in October 2018. The algorithms and process for distributing organs moved from three medical urgency statuses to six statuses plus geographic distribution. The new criteria are designed to transplant the most urgent patients the soonest and broaden geographic access to available organs.

“We’ll provide a snapshot of the new model’s impact over the few months that it has been in operation,” Dr. Haft said. “We will learn who the recipients are currently, how the characteristics of those recipients have changed, and how the new model has impacted distribution, as well as how far centers are now traveling to retrieve organs.”

The session also will review the current evidence on donor heart assessment. There are longstanding guidelines on how to assess donor hearts, but there also is significant variability in practice between transplantation centers. Not all common practices are supported by the current literature.

“Heart transplantation protocols is an area we have not looked at for some time at the STS Annual Meeting,” Dr. Haft said. “This is an important symposium that will potentially influence your practice.”

Top