O2 over ice: Oxygen-powered ‘heart-in-a-box’ keeps donor organ alive for 9 hrs

A heart transplant is a life-saving procedure, but the transportation of a donated heart to its recipient is often a race against time.

To address this, researchers have developed a cutting-edge technology called a “heart-in-a-box.” This device allows donated hearts to be kept alive and functioning outside the body for longer periods.

The University of Gothenburg study found that using this new device for donor heart preservation can significantly lower the likelihood of early heart failure in transplant recipients compared to typical cold storage methods.

Unlike standard cold storage, the heart-in-a-box provides continuous oxygenation and nutrient supply to the heart, helping to maintain its health and function.

This box can store donated organs for up to nine hours

The current standard procedure involves storing donated hearts in ice-filled coolers at 4°C in potassium solution. However, handling donated hearts is a critical time-sensitive process.

To reduce the risk of complications for the recipient, the donor-receiver match, heart transportation, and surgical implantation must all be accomplished within a four-hour window.

This study found that hypothermic oxygenated machine perfusion (HOPE) or a heart-in-a-box device can increase the storage period of donated hearts by up to nine hours.

Compared to traditional static cold storage, this innovative technology keeps the heart at eight degrees. In addition, the device includes a pump, tubing, a reservoir, and a circulating fluid to keep the resting heart oxygenated as it awaits transplantation.

“The oxygenation of the heart that takes place in the box is crucial. During normal cold storage and transportation, we have no oxygenation or circulation in the cells, but when we use the box, oxygenated and nutrient-rich fluid is continuously pumped through the heart, which allows the heart to function better and results in fewer complications in the recipient after the transplant,” explained Andreas Wallinder, MD, PhD cardiothoracic surgeon, who developed this concept.

Heart-in-box vs typical coolers

This study compared the heart-in-a-box with typical cooler storage techniques for donated hearts. The purpose was to evaluate the safety and health results of heart transplant recipients within the first 30 days after the operation.

It involved 204 adult patients from 15 clinics in 8 European countries. The participants were randomly assigned to receive hearts stored in either a heart-in-a-box or a cooler. All of the donated hearts were derived from brain-dead donors.

The researchers discovered that receivers of hearts preserved in a heart-in-a-box had a much lower risk of developing heart failure or severe organ dysfunction (PGD) than those who got hearts maintained in typical refrigerators. Notably, the risk of PGD was 11% lower in the heart-in-a-box group.

“The results represent a breakthrough in transplantation, which could expand the field. Used correctly, the heart-in-a-box can reduce a number of complications that otherwise often result in suffering, poor outcomes, in the worst cases premature death, and also high costs,” said Göran Dellgren, Professor of Transplantation Surgery at Sahlgrenska Academy at the University of Gothenburg.

“In terms of time, organs can also be shipped longer distances, thus making more organs available for transplantation. It is also likely that we can start using less ideal organs from older donors, which could increase the number of heart transplants,” added Dellgren in the press release.

The results have been reported in the journal The Lancet.