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Harefield Hospital first UK centre to routinely use 'beating heart' transplant technology

London, UK - July 9, 2014

Harefield Hospital has become the first transplant centre in the UK to adopt a revolutionary system that enables a donor heart to beat outside the human body before it is transplanted.

In 2013-14, Harefield Hospital carried out 26 heart transplant operations and, in all but one case, the patient received an organ that had been transported and prepared for transplantation using the groundbreaking 'beating heart' technology.

The Organ Care System (OCS™), also known as 'heart in a box', simulates the conditions of the human body, pumping oxygenated blood inside the heart so it can continue to function as it would in a living person.

The innovative system, developed by US company TransMedics®, replaces the traditional 'cold ischemia' (ice preservation) method of transporting the heart, increasing the time the organ can be maintained outside the body to at least eight hours, compared with a maximum of three to four hours on ice.

This means hearts can be retrieved from further afield and transported to Harefield. It also safely preserves the donor heart in the case of a more complex transplant operation, which takes longer to prepare the recipient to be ready to accept the new heart.

Royal Brompton & Harefield NHS Foundation Trust began using the technology in February 2013 because of the number of organs that surgeons were forced to decline due to distance (for example Scotland and the Republic of Ireland) and apparent organ quality when matched to the characteristics of some recipients.

The retrieval team has since been able to accept 'marginal' organs — which might usually have been deemed too risky for the recipient — after the retrieval surgeon was able to assess the 'functioning' heart to consider whether it was suitable for transplantation.

Equally, using the OCS has meant the retrieval surgeon could identify hearts which performed badly, despite initially appearing suitable for transplantation from standard diagnostic tests. This has prevented patients from receiving a donor heart that will not work.

Andrew Britton, 33, from Uxbridge, received a new heart at Harefield last year.

The keen sportsman's life was turned upside down in November 2012 when he fell ill on honeymoon in the Maldives. He was transferred by an emergency medical jet to Bangkok where he spent two weeks between life and death.

Once well enough to return to the UK, he was taken straight to Harefield Hospital where he was diagnosed with myocarditis — a viral infection that leads to inflammation and damage to the heart.

Andrew's heart had been so badly damaged that he needed a mechanical device to support it, whilst it became clear the only long term option was a transplant. He spent six months on the urgent waiting list as an inpatient at Harefield until a suitable match became available.

When it finally did, the retrieval team travelled to the donor hospital and carried out diagnostic tests that indicated the heart to be suitable for transplantation.

Under normal circumstances and due to Andrew's previous surgery to implant a mechanical device, his operation would have started immediately after the donor heart was deemed transplantable — a few hours before the organ actually arrived in Harefield.

However, when it was monitored on the OCS during transportation to the hospital, there was subtle evidence the heart was not performing as it should. In the meantime, Andrew was kept under anaesthesia with the surgeon at Harefield ready to begin. As time passed it became clear that the donor heart was not suitable for transplantation. This meant Andrew was saved from receiving a potentially life-threatening organ.

Andrew's surgeon, Mr Fabio De Robertis explained:

"By normal standards this heart would have been accepted, put on ice and restarted once it had been transplanted into Andrew. The OCS gave us the opportunity to monitor the heart's performance over a number of hours. What began as a subtle problem became gradually worse. This led me to decide not to go ahead with the transplant.

"It is a huge decision to make at the time because, of course, patient and surgeon have to live with the consequences. Ultimately, however, it proved to be the correct call. Had we implanted this heart — which we have subsequently studied for research purposes — Andrew's chances of survival would have been just one or two per cent.”

A suitable heart was eventually found and again retrieved using the OCS. Andrew's operation proved to be particularly complex, but the donor heart was kept 'beating happily' on the system for as long as it took to prepare his chest to receive it.

Andrew had the successful transplant operation towards the end of last year. He was well enough to leave hospital in November 2013, almost a year to the day since he first collapsed on honeymoon.

Andrew and his wife Lauren are now preparing for the birth of their first child later this year.

Mr De Robertis added:

"I bumped into Andrew some months after I did his successful transplant and at first could not place him. He looked so physically fit compared with the skeleton I had first met at Harefield. It was an emotional moment for me to see him doing so well and to hear his and his wife's wonderful news.”

In addition to helping increase the total number of transplant procedures carried out at Harefield Hospital, the OCS has proved to be invaluable for patients who, like Andrew, have a Ventricular Assist Device (VAD) — sometimes known as an 'artificial heart' — keeping them alive as a 'bridge to transplant'.

In the four year period between January 2010 and December 2013 there were 271 long term devices implanted into adult patients across the whole of the UK. However, only 47 patients with these devices received a heart transplant in the same period — an average of less than 12 per year nationwide.

Since the Trust began using the OCS in February 2013, Harefield Hospital alone has been able to transplant 17 VAD patients (until end of June 2014), compared with just seven patients in the previous three years combined (2010-2012).

Mr André Simon, consultant surgeon and director of transplantation, said:

"This new technology has enabled us to increase the organ offer-to-transplant conversion rate. Put simply, it means that patients at Harefield have had life-saving heart transplants which otherwise would not have been possible — primarily because we have travelled greater distances to retrieve an organ and have been able to transplant many more patients who already have an implanted device keeping them alive.

"Harefield has the largest number of patients with VADs in the UK and transplantation in these circumstances is particularly complex. It requires greater skill and time to safely remove the device and prepare the chest cavity to receive the donor heart. The OCS allows our surgeons precious surgical time and means that more of these patients are having transplant procedures.

"For us the OCS technology has become the gold standard for organ retrieval. It means we can transplant more patients and has resulted in patients spending less time on intensive care and in hospital post transplant compared with previous years. We have also reduced the incidence of post-transplant heart failure.”

For further information, please contact:
Mark Fenwick.
Head of media relations
Royal Brompton & Harefield NHS Foundation Trust
Tel: 020 7351 8672 Mobile: 07866 536 345
Follow us on Twitter: @RBandH

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