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Texas Medical Center

Baylor St. Luke’s Performs First Heart Transplant Using Cardiac Death Donor

HOUSTON, TX (April 19, 2024) - A man in his early 20s with end-stage heart failure became Baylor St. Luke’s Medical Center’s first recipient of a new heart from a relatively new form of heart transplant donor. It is hoped this will increase the donor pool for the thousands of people waiting for this vital organ.

The 7½-hour surgery in January was the hospital’s first heart transplant that didn’t involve a traditional donor, or someone who is brain dead. Heart transplantation using brain dead donors has been the standard practice in the United States for decades. In this case, the patient received a donation-after-cardiac-death heart, where all the circulatory and respiratory functions of the donor had stopped. 

A system to perfuse, preserve and assess a donor heart’s condition and viability before transplantation is the key ingredient that had been missing, said Andrew Civitello, MD,  medical director of the heart transplant program at Baylor St. Luke's and associate professor of medicine-cardiology at Baylor College of Medicine.

The TransMedics® Organ Care System™is a portable machine that uses warm oxygenated perfusion to preserve a donor heart for transplant.  It includes a monitoring system that checks key parameters of the donor heart function for physicians to use in making an assessment for transplantation. Other organs, such as the liver and kidneys, had previously been harvested from donation after cardiac death donors, but the heart doesn’t rebound as easily from lack of blood supply.

“It's really revolutionized what we do. It's a very different process for us,” Dr. Civitello said. “We think that it's going to really open up the donor pool. In some European countries and the U.K. where they adopted this a lot faster than we have in the U.S., the donor pool has increased by 30%. That’s huge. That's absolutely huge, and that's why we're so excited about it.”

In the U.S., 7,519 candidates were actively awaiting heart transplants in 2022, according to the latest data from the Scientific Registry for Transplant Recipients. During the same period ‒ from Jan. 1 to Dec. 31, 2022 ‒ 3,668 heart transplants were performed in the U.S.

A typical cardiac death donor could be someone who suffered a traumatic brain injury or a respiratory injury and was ventilator-dependent and their care is futile, or a patient and/or a family who decides to cease life support but the donor doesn’t meet the criteria for brain death, Dr. Civitello said. 

As for the heart itself,  all donated organs may not recover and some have to be discarded. The patient outcomes are at least as successful as from donors after brain death, he said.

“If you take a step back and you look at who is alive a year after transplant, the outcomes are actually, at the very least, equal. And actually, in one of the Australian (study) papers, the outcomes were actually a little better. I think it probably had to do with patient selection, but it's at least as good.”

The Baylor St. Luke’s patient, who was desperately sick and on the most aggressive form of life support before his transplant, is doing really well now.

“I saw him the other day walking in. He was coming in for a clinic visit, and he was walking in the hallway all smiles with his mom,” Dr. Civitello said.

The transplant was performed by Alexis Shafii, MD, surgical director of the hospital’s heart transplant program. Kenneth Liao, MD, director of the hospital’s cardiothoracic transplant program, led the team that harvested the heart, placed it on the Organ Care System and transported it back to Baylor St. Luke’s.

Civitello is excited about how this new donor pool can potentially save more lives at the hospital. 

“Anything that we can do to increase the donor pool and get these people transplanted is absolutely, absolutely huge,” he said. “It's earth shattering.”

About Baylor St. Luke’s Medical Center

Baylor St. Luke’s Medical Center is an 881-bed quaternary care academic medical center that is a joint venture between Baylor College of Medicine and St. Luke’s Health. Located in the Texas Medical Center, the hospital is the home of the Texas Heart Institute, a cardiovascular research and education institution founded in 1962 by Denton A. Cooley, MD. The hospital was the first in Texas and the Southwest designated a Magnet Recognition Program hospital for Nursing Excellence by the American Nurses Credentialing Center, receiving the award five consecutive times. Baylor St. Luke’s also has three community emergency centers offering adult and pediatric care for the Greater Houston area.

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