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VA research in action
Keeping donor organs viable for transplant
The image shows a donor liver being kept viable for transplant with a device developed in part by VA researchers. (Photo courtesy of TransMedics)
VA researchers and colleagues invented technology that will improve the number and effectiveness of organ transplants. Working with the company TransMedics, Inc., VA researchers developed a technique called “warm perfusion,” which keeps transplant hearts and other organs viable using an artificial circulatory system.
The device pumps blood, oxygen, and electrolytes into an organ while it is outside the human body. The organ is placed in a chamber in the device connected to tubes, which provide a continuous supply of oxygenated blood to the organ. The device also maintains temperature and pressure. The technique was patented by VA and licensed to TransMedics, which developed the technology.
TransMedics makes warm perfusion machines for heart, lung, and liver transplants. The heart and lung machines are approved for use in the United States by the Food and Drug Administration, while the liver machine is currently in clinical trials.
In a U.S. first, Duke University surgeons in 2019 used warm perfusion to revive a heart and transplant it into a patient. The transplant recipient was a U.S. Veteran who received the heart through the MISSION Act. The procedure was first performed in the United Kingdom in 2015. Warm perfusion has now been used multiple times in Australia and parts of Europe.
Organ donations usually come from organ donors declared brain-dead but whose hearts are still pumping. Heart tissue and other organs deteriorate rapidly when deprived of oxygen. So by the time a donor’s heart stops beating and death is declared, organs are often no longer usable for transplant. Without this new technology, an organ is only viable for a few hours when kept on ice outside the body. Warm perfusion extends this time to as long as 12 hours.
By allowing organs to be transplanted after cardiac death, the new technology could dramatically increase the supply of donor organs. Over 100,000 patients in the United States are on the waitlist for new organs. Because the supply of donated organs is limited, many patients die while waiting for a transplant.
Principal investigators: Dr. Waleed Hassanein, TransMedics, Inc.; Dr. Shukri F. Khuri, VA Boston Healthcare System; Dr. Michael Crittenden, VA St. Louis Healthcare System; Dr. Vladimir Birjiniuk, Mt. Auburn Hospital, VA Boston Healthcare System
Research partners: TransMedics, Inc.
Hassanein W, Khuri SF, Crittenden MD, Birjinuik V, inventors. The United States of America as represented by the Department of Veterans Affairs, assignee. Compositions, methods and devices for maintaining an organ. United States patent US 6,953,655 B1. 2005 Oct. 11.
Hassanein W, Khuri SF, Crittenden MD, Birjinuik V, inventors. The United States of America as represented by the Department of Veterans Affairs, assignee. Compositions, methods and devices for maintaining an organ. United States patent US 8,409,846 B2. 2013 April 2.
Continuous perfusion of donor hearts in the beating state extends preservation time and improves recovery of function. Hassanein WH, Zellos L, Tyrrell TA, Healey BA, Crittenden MD, Birjiniuk V, Khuri SF. Journal of Thoracic and Cardiovascular Surgery. 1998 Nov;116(5):821-830.
Doctors pump new life into dead donor heart in US first. Sparks H. New York Post. Dec. 2, 2019.
Heart from dead donor revived, transplanted into veteran in US first. Farber M. Fox News. Dec. 3, 2019.
Doctors restore heart from dead donor outside the body. Digon S. International Business Times. Dec. 3, 2019.
Donated organs kept ‘alive’ may ease the transplant shortage. Bernstein L. Washington Post. May 22, 2016.