Non-beating heart transplants: trial under way in the United Kingdom

An “unprecedented” procedure to transplant non-beating hearts and “restart” them using electrical energy would increase the annual number of heart transplants in the United Kingdom by 42%. The procedure would thus cut the waiting list for heart transplant patients by almost a half.

It involves removal of the non-beating hearts of deceased patients as opposed to the hearts of brain-dead patients. A trial has been under way in three hospitals in the United Kingdom since 2015 and doctors believe that the results are better than those obtained with the hearts of brain-dead patients that are still beating. At Papworth Hospital in Cambridge, thirty non-beating heart transplants have been carried out since 2015. Doctors are enthusiastic: “Before, we were unable to use these hearts for transplantation because they had stopped beating but this new procedure allows the organ to start beating again using a ‘beating machine’, which restores the energy supply during the journey from the donor hospital to the recipient hospital”. Three other hospitals are expected to apply the procedure next year. The only country in Europe, and the second country in the world to carry out these trials after Australia, the United Kingdom is delighted with the results: “The rest of the world is interested because they have seen our results and the patients who have survived. Doctors in the Netherlands, France, Spain, Canada and other individuals have come to learn how to carry out these techniques. But none of them has actually used this approach to date”.

Note from Gènéthique:

The harvesting of non-beating hearts poses certain ethical problems, essentially the uncertainty of restarting the heart and the risk of spin-offs from medical teams faced with a high demand for transplants and a small number of donors.

Deceased non-beating heart donors were classified according to four categories during an International Conference in Maastricht in 1995:

·         persons who suffer a cardiac arrest outside the medical setting and are dead on arrival of ambulance personnel  (Maastricht category I).

·         persons who suffer a cardiac arrest in the presence of a life medical team capable of administering effective heart massage and mechanical ventilation but whose resuscitation is unsuccessful (Maastricht category II);

·         persons for whom a decision to stop treatment or limit treatment is taken due to disease prognosis and who will require resuscitation (Maastricht category III[SA1] );

·         brain-dead persons who suffer an irreversible cardiac arrest during resuscitation (Maastricht category IV).

Independent, May Bulman (9/09/2017)