New Options Make It Possible for More People to Receive Heart Transplants

Many factors determine which donor hearts are eligible for transplant and how they are matched to recipients. As a result, only about 20% of donor hearts are accepted for transplant while many viable hearts go unused for a variety of reasons, says Duke transplant cardiologist Adam DeVore, MD. Duke is participating in clinical research and innovative programs with the goal of reducing wait times and increasing the number of hearts available.

Duke is one of a handful of U.S. centers involved in a clinical trial studying a new way to transplant donated hearts that could not be used before. Traditionally, a heart can be recovered for donation only after the donor meets strict criteria for brain death following a severe, irreversible neurologic injury. (The heart must still be beating well to be used for transplant.) However, some people with severe, irreversible brain injuries may not meet all of these strict criteria for death. Using a process known as Donation after Cardiac Death (DCD), the loved ones of these carefully selected patients choose to remove life support, and the heart is allowed to stop in a very controlled way. Then the heart is recovered for transplant. This process is already used in the U.S. for other organs like lungs, livers, and kidneys, and in Europe and Australia for hearts. 

Another goal of the trial to evaluate a device that circulates warm, oxygenated blood through the donor heart, allowing it to beat outside of the body. This keeps the heart viable much longer than the standard preservation process. It preserves recovered hearts and allows for testing before transplantation. It also means hearts can travel farther to reach intended recipients.

Another way to expand the donor pool is by accepting hearts that would not have been accepted for transplant in the past, such as those from donors with hepatitis C. Now that well-tolerated medication is available to cure hepatitis C, research has proven that these hearts are safe for transplant. Receiving one can reduce your wait time for an organ. While these hearts are classified as higher risk, the Duke transplant team only chooses hearts that are in good condition otherwise.

Dr. DeVore said people who are offered these hearts receive a complete explanation of the benefits and risks, including the chance of contracting hepatitis C. “We work with patients to help them weigh that against the risk of waiting longer for a heart transplant,” he said. “It’s important to note that today’s hepatitis C medicines are very effective, have few side effects, and do not interact with the immune-suppressing medicines required after heart transplantation.”

A big challenge for people with heart failure is not getting sicker while they wait for a heart. A left ventricular assist device (also called a VAD or an LVAD) may help in this situation. These surgically implanted devices replace some of the work of the heart, allowing it to rest and improving your health and quality of life while you wait. Duke’s robust LVAD program is run by a team of experts who are devoted to teaching you how to live with the device while waiting for a transplant, or, sometimes, in lieu of one.

The presence of certain antibodies -- such as anti-human leukocyte antigen (HLA) -- in the blood can increase the likelihood of organ rejection after transplant. Often, it makes the wait for a heart even longer, because a donor heart’s tissue must be a good match for the transplant recipient’s antibodies. However, a “match” is not always black and white. In some cases, reactions between the recipient and the donor heart can be treated to prevent rejection. Duke cardiologists are developing more precise ways to measure antibodies, predict mismatch, and treat interactions.

Sometimes a heart transplant is not recommended because another organ (for example, the kidneys or liver) is also failing, and a transplant surgery would be too risky. For people like this, Duke has expertise in performing multi-organ transplants (including heart-kidney, heart-liver, and heart-lung transplants) and caring for recipients afterward.

If you have been turned down for a transplant at another institution or are interested in making an appointment for an evaluation, call 855-855-6484 or ask your cardiologist to submit a referral form.