For all you Grey’s Anatomy fans out there who wondered if “heart-in-a-box” was real, it is now – and it works. Transplant surgeons have started using a device that allows them to keep a disembodied heart alive until it can be used to save another.
The “Organ Care System” (OCS) from TransMedics works by securing the heart in a sterile chamber. Within it, everything from humidity to temperature is kept stable at conditions similar to those within the human body. Once collected, the heart is hooked up to a supply of the organ donor’s blood, which the machine infuses with the oxygen and nutrients it needs to stay alive. The portable console it sits on houses a pump that is used to maintain pulsatile flow, or the flow of blood.
“A monitor also provides important information to allow assessment of the organ by the physician,” says the TransMedics team. “In the case of the heart, parameters such as aortic pressure, coronary flow, blood temperature, and heart rate are monitored.”
According to MIT, about 2,400 heart transplants occur each year in the U.S., and if approved for wider use, this kind of tech could increase that number by a whopping 15-30 percent. It doesn’t stop there: the system could also be used to support other organs, like lungs, kidneys, and livers.
OCS is still in clinical trials in the U.S., but it’s already lent a helping hand in 15 successful heart transplants across Europe and Australia.“The device is vital,” says Papworth Hospital surgeon Stephen Large, who has used the system as part of eight heart transplants. “The heart gets an absolutely essential infusion of blood to restore its energy,” which you don’t get from on-ice storage. (Out with the cold, in with the new?)
Interestingly, in seven of Large’s eight surgeries, his team actually restarted the dead heart while it was still inside the donor’s body. Once the heart stopped beating, he and his team waited five minutes (the medical standard), then quickly clamped off the blood supply to the brain and restarted the heart without removing it – essentially turning a dead patient into a “brain-dead, beating heart donor.”
“With the heart pumping [in the body],” explains Large, “it’s possible to check its condition with accuracy and also maintain the blood flow to the kidney and liver, preserving those organs as well.”
As you can imagine, this has raised some ethical debate within the medical community, and not everyone is convinced just yet. Is a person whose heart can be restarted really dead? Some, like Harvard University medical ethicist Robert Truog say no.
“My argument is that they are not dead, but also that it doesn’t matter so long as they and family members have given consent,” he told MIT. “They are dying and it’s permissible to use their organs. The question is whether they are being harmed, and I would say they are not.”