Surgeons at the Puerta de Hierro Majadahonda University Hospital in Madrid recently performed a heart transplant using a donor who died of cardiac arrest. This is the first time a transplantation has successfully taken place in Spain using this type of donor.
The donation of organs from people who die after a cardiac arrest, also called donation “in controlled asystole”, have been carried out for a number of years using organs including kidneys, or liver - but not hearts. Heart transplants had previously only been performed using donors who have suffered brain death.
This new transplant technique could open the door to a significant increase in the number of organs available for patients on transplant waiting lists.
It was previously considered that hearts in controlled asystole were unsuitable for transplantation, but an increasing number of successful cases seen in countries such as Australia, Belgium, the United Kingdom and the USA proved that these organs are functional and can save lives.
The director of the National Transplant Organisation (ONT), Beatriz Domínguez-Gil said that the possibility of donating hearts in controlled asystole would increase the number of suitable organs "by between 5% and 10%."
Alberto Forteza, head of the Cardiac Surgery Service at the Madrid hospital, explained the procedure at a press conference: "The heart of the deceased patient is recovered before the extraction, thanks to a heart-lung machine (called ECMO) that infuses the patient with oxygenated blood and keeps the organ functioning."
This procedure, added Juanjo Rubio, head of the hospital's Intensive Care Unit, offers several advantages over other techniques. "The assessment of the heart's functioning is done under physiological conditions, and the proper functioning of the organ can be better confirmed.”
Currently there are only two hospitals in Spain endorsed by the Permanent Transplant Commission of the Interterritorial Council of the Spanish National Health System to perform this type of transplant, which are the Puerta de Hierro Majadahonda University Hospital in Madrid and the Bellvitge Hospital in Catalonia.
The patient who received the organ, Jorge W. Pavón, suffered from a debilitating hereditary disease that affects the heart. Thanks to the pioneering procedure, Mr Pavón will now have a whole new lease on life.
Mr Pavón explained: "When they told me about the operation, I immediately agreed, without doubt, because my condition was very bad. I spent more time in the hospital than at home."
Marina Pérez, coordinator of transplants at the hospital, wanted to highlight the importance of coordinating a team that included surgeons, cardiologists, anaesthetists, the intensive care team, neurologists, nurses, assistants and other health professionals. She also thanked the family for their generosity, thanks to which a liver, kidneys and tissues were also transplanted into other patients.
According to ONT data, 300 heart transplants were performed in Spain in 2019. In 50% of the cases, added Dominguez-Gil: "The transplant was performed in less than three months. Despite developments there are still currently 149 people waiting for a heart, 20 of them are children.”
Successfully transplanting a heart donated after death from cardiac arrest, is a very complex process, said the team involved in the operation. The heart is particularly sensitive to ischemia (lack of blood supply), so it is necessary to be extremely precise and coordinated in order to act as quickly as possible.
Asystole donation in Spain has grown significantly in recent years. This pioneering case demonstrates promise that numbers will continue to rise.