Prolonged Preservation of the Heart Prior to Transplantation
Uploaded by Admin on Jan 22, 1999
Picture this. A man is involved in a severe car crash in Florida which has left him brain-dead with no hope for any kind of recovery. The majority of his vital organs are still functional and the man has designated that his organs be donated to a needy person upon his untimely death. Meanwhile, upon checking with the donor registry board, it is discovered that the best match for receiving the heart of the Florida man is a male in Oregon who is in desperate need of a heart transplant. Without the transplant, the man will most certainly die within 48 hours. The second man's tissues match up perfectly with the brain-dead man's in Florida. This seems like an excellent opportunity for a heart transplant. However, a transplant is currently not a viable option for the Oregon man since he is separated by such a vast geographic distance from the organ. Scientists and doctors are currently only able to keep a donor heart viable for four hours before the tissues become irreversibly damaged. Because of this preservation restriction, the donor heart is ultimately given to someone whose tissues do not match up as well, so there is a greatly increased chance for rejection of the organ by the recipient. As far as the man in Oregon goes, he will probably not receive a donor heart before his own expires.
Currently, when a heart is being prepared for transplantation, it is simply submerged in an isotonic saline ice bath in an attempt to stop all metabolic activity of that heart. This cold submersion technique is adequate for only four hours. However, if the heart is perfused with the proper media, it can remain viable for up to 24 hours. The technique of perfusion is based on intrinsically simple principles. What occurs is a physician carefully excises the heart from the donor. He then accurately trims the vessels of the heart so they can be easily attached to the perfusion apparatus. After trimming, a cannula is inserted into the superior vena cava. Through this cannula, the preservation media can be pumped in.
What if this scenario were different? What if doctors were able to preserve the donor heart and keep it viable outside the body for up to 24 hours instead of only four hours? If this were possible, the heart in Florida could have been transported across the country to Oregon where the...