Transplant Technology Preserves Donor Hearts to Save More Lives

Heart transplantation may be a solution for some people living with advanced heart failure when other therapies have failed. In the United States, thousands of people wait on the transplant list due to a limited number of donors. University Hospitals Harrington Heart & Vascular Institute has implemented novel approaches to widen the donor pool and provide more patients with lifesaving, donated hearts.

Multiple Infections Leads to Years of Heart Issues

Nick Mitchell of Shaker Heights is one of those patients who has benefited from these efforts. He was healthy and in his early 30s, but after catching a bug from another passenger on a plane, he went to urgent care with symptoms of a cough and low energy. Providers discovered Mitchell’s oxygen levels were at 50 percent. He went immediately to UH Ahuja Medical Center for further testing.

“They found double pneumonia, flu, strep throat, and two ear infections,” said Mitchell.

Caregivers also discovered he had an enlarged heart and an ejection fraction (EF) of only 15 to 20 percent. A normal heart’s EF is between 55 and 70 percent. EF is an indication of how well the heart is pumping out blood and can help to diagnose and track heart failure.

The diagnosis turned into a 10-day hospital stay and the beginning of a years-long journey with heart issues. Mitchell would experience periods with few or no symptoms, then battle a bout of exhaustion and coughing and be admitted to the hospital.

As Condition Worsens, a Heart Transplant Becomes Critical

“The clinical term for Nick’s condition was non-ischemic cardiomyopathy,” said Eiran Gorodeski, MD, MPH, cardiologist with UH Harrington Heart & Vascular Institute, and medical director of the Advanced Heart Failure & Transplant Center. “That means his heart had decreased function caused by something other than a heart attack. From this, he developed heart failure. We monitored his condition and prescribed medications, then advised implanting a defibrillator, and eventually it became clear we needed to get him on the transplant list.”

Mitchell’s condition worsened and his defibrillator began administering shocks because his heart was out of rhythm or stopping. He was admitted to the intensive care unit at UH Cleveland Medical Center and was moved up the transplant list.

“Finding a donor for Nick was harder and prolonged because he’s a bigger and taller guy,” said Yasir Abu-Omar, MD, surgical director of the heart transplantation program at UH Harrington Heart & Vascular Institute. “This makes the pool for donors smaller.”

Perfusion Technology Keeps Donor Hearts Healthy for Longer

Luckily for Mitchell, UH had begun the process of widening its heart transplant donor pool by expanding the types of donors that are considered to be acceptable, and by using new technologies to preserve the donor hearts once they are outside the body.

“Nick benefited from an advance in heart transplantation called ex vivo organ preservation,” said Dr. Abu-Omar.

With this technique the heart is perfused with blood on a machine once it has been removed from the body – keeping the heart tissue alive and beating in a box. This is important for organs such as hearts and lungs which have shorter windows of time to make it to the recipient compared to kidneys. This makes it possible to increase transportation time, enabling matching hearts to come from farther away. This was beneficial in Mitchell’s case. In August 2023 he was UH Harrington Heart & Vascular Institute’s first heart transplant recipient to benefit from this technology.

“We have been working hard to finds new ways to identify and preserve donor hearts. Maintaining a donor heart beating outside the body is a paradigm shift. We are thrilled to make this technique available to our patients at UH,” said Dr. Abu-Omar.

The first similar use of this technology for this type of heart transplantation was reported in Australia in 2015, in the UK in 2016, and in the U.S. in 2019. The technology received FDA approval for use in heart transplantation in 2021. UH Harrington Heart & Vascular Institute has completed three heart transplants using ex vivo preservation since launching the program.

New Strategies Widen Donor Pool Further

UH is going even further to widen its donor pool with strategies like using hepatitis C-positive donors and using temperature-controlled transport systems for donated hearts.

“Traditionally when you put a heart on ice some of the tissue becomes injured while in transport,” said Dr. Gorodeski. “We now routinely use containers where donated hearts are better preserved so the heart makes it to the recipient in better shape. As for hepatitis C-positive donors, it’s more challenging to find a heart that’s a match than to cure someone of hepatitis. We can cure them of the disease after-the-fact. It’s just another barrier we can overcome to provide more hearts to those in need.”

Mitchell was discharged from the hospital about three weeks after his transplant.

“If you would tell me I had a transplant six months ago I wouldn’t believe you,” he said six months after his surgery. “I just don’t feel like that.”

Before he got sick, Mitchell lived an active life of exercising, playing basketball and flag football, going fishing and hanging out with friends. After months of cardiac rehabilitation and working back up to “normal” he has returned to doing more of the things he loves.

“For the first time in years I can run and just tire myself out. I don’t feel like my heart is tired and stopping me from being active,” said Mitchell.

“Being able to do a heart transplant was crucial in Nick’s case,” said Dr. Gorodeski. “Widening the donor pool through multiple avenues means we can complete more transplants and save and improve more lives like Nick’s.”