There’s a very small window of time to use a donor heart – once outside the donor’s body, it’s only viable for transplant for a few hours, depending on the method of preservation. But Transmedics is about to change all of that with a controversial device that brings hearts back from the dead. (And if you listen closely, you can hear the echoes of the villagers from Frankenstein shouting and waving their pitchforks.)
The “Organ Care System” secures the heart in a sterile chamber that mirrors the humidity and temperature of the human body. Attached to a supply of the organ donor’s blood, the machine also pumps oxygen and nutrients to keep the heart beating. The technology may be able to increase the supply of hearts for transplant by approximately 15 to 30 percent. It’s not just for hearts, either – the Organ Care System is able to support lungs, kidneys, and livers for transplant as well.
So far, it’s assisted 15 successful heart transplants in Europe and Australia, and it’s currently undergoing clinical trials in the U.S. Doctors claim that it can extend the heart’s survival time outside the body and allow them to use hearts from previously ineligible donors.
Heart transplants usually only come from brain-dead donors, because the heart is still viable for transplant even if brain function has ceased. But there is a shortage of brain-dead donors. So it would make sense to use the technology on those with “circulatory death” because it might be able to revive the heart if it’s hastily hooked up to the Organ Care System. In the U.K., it could increase the supply by almost a third, adding 50 to the annually available 180.
But if a potential donor patient’s heart does stop, how long should the surgeon wait before carving out the heart and reviving it? The current accepted standard is five minutes, but if the heart can be revived with the Organ Care System and placed into a new patient, why not put it back in the old patient to give them a shot at survival?
There are so many ethical issues to consider now that technology has allowed us to restart failed hearts. Is the donor really dead if the heart can be brought back to life? When the body is deprived of oxygen for that long, the donor’s going to wind up with severe brain damage or complete brain death anyway. Then we move into the ethical gray area of keeping brain-dead patients alive, despite that their hearts might be able to give someone else a real shot at life.
You would have to weigh the options of each. If the donor’s heart has stopped long enough for their brain damage to severely impact their quality of life up to and including brain-death, and the recipient has a favorable chance of surviving and even thriving, it would make sense to transplant it into the patient with the greater chance at a full life. It’s a chillingly rational way to evaluate two human lives hanging in the balance, but the patient with a higher likelihood of survival, in my opinion, should get the heart.
The real issue arises when the chances at full recovery are equal. At that point, the decision would most likely rest on the donor family or the donor’s wishes – though a donor’s untimely death would certainly complicate this, considering the patient and family would likely not have an action plan. This is far too subjective of a decision for me to make, obviously. However, time is of the utmost essence in this situation – the heart is only viable for the revival machine for a short period of time. It’s an impossible decision to make, even more so with haste.
Regardless, the fact that technology like this can keep organs actually functioning after patient death should be able to drastically shorten transplant lists for the other organs it can keep alive, which are far less controversial than the heart. Only time will tell if some mad scientist tries it on an entire dead person. I’m getting to work on a modern-day Frankenstein novel as we speak.
What do you think? If a donor heart can be revived, who should get to keep it? Anyone out there willing to publish my updated Frankenstein novel?