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AMAZING Living Human Heart in Box! Medical Breakthrough 2017

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- There have been numerous advancements since the first human organ transplant (kidney) occurred in 1954. However, the method in how the organ is delivered from donor to recipient as remain the same - via a cooler

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- Each year more than 5,000 heart transplants are performed globally. It is estimated that up to 50,000 people are in need of a heart transplant

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- The 1-year survival rate is over 80% for heart transplant recipients with an average length of survival of 9.1 years.

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Figure A: Illustrates where the recipient's failing heart is cut for removal. Figure B: Illustrates where the healthy donor heart is stitched to the recipient's arteries and veins.

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- In many cases, organ transplantation remains the only effective therapy for end-stage organ failure (Guibert & Petrenko, 2011)

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The heart is removed from the donor and bathe in a salty preservation solution. Afterwards, the heart is placed on ice and transported in a cooler.

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Despite many of the advances regarding organ transplant, ensuring the survival and viability of the transplanted organ remains imperfect.

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The current standard of transporting donor hearts in iceboxes has the heart in a non-functioning state. Once the heart is placed inside the recipient, the heart has to be restarted.

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Over 815 successful organ transplants have been performed through using the TransMedics perfusion devices worldwide.

The Heart in a Box is commercially available in Europe and Australia. It is currently under clinical investigation in the United States.

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In sum, advancements in medical technology are one of the keys to opening the doors to improving the quality of care. The Heart in a Box can improve health and increase efficiency through a myriad of ways:
1) Improve patient outcomes
2) Increase the number of available hearts that are eligible for donation
3) Expand the pool of potential donors

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The TransMedics Organ Care System allows living organ transport to be performed. The heart is transported in a portable, warm perfusion system.

This method has the potential to overcome many of the limitations associated with the cold ischemic storage that has been in placed for over 50 years:
+ By pumping warm, oxygenated, nutrient-rich blood through the heart from the time of removal until it is implanted, the heart may survive longer periods of time outside of the body.
This can solve the geographic dilemma that the cooler method imposes.  Organs remain viable up to 4 hours in a cooler. The box pumps  warm, oxygenated blood through the heart. This allows the heart to be viable outside a body longer.
+ The heart will be less vulnerable to damage during transportation.
Patient outcomes are expected to improve as damage to the transplanted heart is minimize. Since the heart is still functioning during transport, doctors can monitor the heart and even make it healthier. For example, antibiotics can be administered to prevent infection.
+ Transporting the heart in the box allows more time to perform extensive testing for function and tissue matching.
With the extended time frame that a transplanted organ can be outside a body, more time for testing can be conducted to ensure the best possibly match and minimize rejection.

The benefits that the "Heart in the Box" provides addresses the concerns rise in the paper "Heart Transplantation Research in the Next Decades" on how to improve heart transplant outcomes.

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The donor heart can be kept in the box for as long as 12 hours (Stamp & Shah, 2015).

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Below is a picture of the TransMedics Organ Care System.

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One of the downsides is that the current cost for the Heart in A Box is $250,000. However, with more research into this technology, perhaps the cost to manufacture this technology will decrease.

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Guibert, E. E., Petrenko, A. Y., Balaban, C. L., Somov, A. Y., Rodriguez, J. V., & Fuller, B. J. (2011). Organ Preservation: Current Concepts and New Strategies for the Next Decade. Transfusion Medicine and Hemotherapy,38(2), 125-142. doi:10.1159/000327033

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Shah, M. R., Starling, R. C., Longacre, L. S., & Mehra, M. R. (2012). Heart Transplantation Research in the Next Decade—A Goal to Achieving Evidence-Based Outcomes. Journal of the American College of Cardiology, 59(14), 1263-1269. doi:10.1016/j.jacc.2011.11.050

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Stamp, N. L., Shah, A., Vincent, V., Wright, B., Wood, C., Pavey, W., . . . Larbalestier, R. (2015). Successful Heart Transplant after Ten Hours Out-of-body Time using the TransMedics Organ Care System. Heart, Lung and Circulation, 24(6), 611-613. doi:10.1016/j.hlc.2015.01.005