The Bellvitge University Hospital performs the first heart transplant from a donor with a stopped heart in Catalonia

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The surgical act was performed in May with a donor from the same hospital.

The recipient is a 54-year-old man affected by dilated cardiomyopathy who has already been discharged and is progressing favorably from the intervention It is the first transplant of this type in Catalonia and the 8th in Spain.

Worldwide, this procedure has also begun to be performed in the United States, United Kingdom, Australia and Belgium.

This May, a heart transplant was performed successfully at the Bellvitge University Hospital from a heart taken from a deceased donor in controlled asystole (stopped heart) at the same hospital. This surgical act represents an innovative activity in Catalonia and opens the door to a new source of hearts available for transplantation.

Until now, Catalonia had successfully transplanted all types of organs (kidneys, lungs, livers and pancreas) from asystole donors, with the exception of the heart. The recipient is a 54-year-old man affected by dilated cardiomyopathy who has already been discharged and is progressing favorably from the intervention. It is the first transplant of this type in Catalonia and the 8th in Spain. Worldwide, this procedure has also begun to be performed, in recent years, in the United States, United Kingdom, Australia and Belgium.

Asystole organ donation occurs from donors who die after cardiorespiratory arrest. This cardiorespiratory arrest implies that the organs deteriorate rapidly due to the lack of blood flow, so the donation process is more complex than that after a death due to brain death.

Dr. Eva Oliver, intensive care physician and member of the Bellvitge Hospital Transplant Coordination team, explains that, in this case, “the donor died as a result of an irreversible neurological pathology. If the cause of death had been a heart problem, logically the heart would not have been suitable for transplantation ”. Once the death was certified, a series of procedures were performed to regain the function of the heart and be able to evaluate it for transplantation. The donor's kidneys and liver were also transplanted.

The preparation of the heart

During the extraction of the heart, a perfusion circuit is established that allows it to recover its functionality through the supply of oxygenated blood and also allows its functional assessment by the medical team. The extraction technique used in this case was normothermic regional perfusion (NRP) in the donor, with ECMO. It is a technique that keeps the donor's blood circulating, once death is certified, to keep the organs oxygenated, followed by a static cold preservation of the graft. If the heart is in adequate condition, it is implanted like a brain-dead donor heart transplant.

The results are comparable and there are no significant differences. "The criteria necessary to be able to extract and later implant these hearts are very strict, specific and controlled", highlights Dr. Fabrizio Sbraga, cardiac surgeon at Hospital de Bellvitge. The Bellvitge Hospital transplant coordination team, in addition to being endorsed by the results and long experience in donation, has had the support of professionals from the Royal Papworth Hospital in the United Kingdom, a center that counts more than 100 interventions of this type since the start of his heart transplant program with donors in controlled asystole in 2015. "It is a complex type of donation, for which our hospital is the only one that is currently prepared in Catalonia", highlights Dr. Nicolás Manito, director of the transplant programs at Hospital de Bellvitge.

Heart transplantation

In 2019, 300 heart transplants were performed in Spain, 71 of them in Catalonia and 25 of these at the Bellvitge Hospital. In 2020, due to the COVID-19 pandemic, the number of heart transplants in Spain dropped to 278. The results of all these interventions are excellent, with a survival of transplants in Catalonia of 79% at five years.

According to Dr. José González Costello, cardiologist at the Hospital de Bellvitge, "it is estimated that the heart transplantation program for non-heart beating donors could increase the availability of hearts for transplantation by 10% in Catalonia."

The preparation of the heart

During the extraction of the heart, a perfusion circuit is established that allows it to recover its functionality through the supply of oxygenated blood and also allows its functional assessment by the medical team. The extraction technique used in this case was normothermic regional perfusion (NRP) in the donor, with ECMO. It is a technique that keeps the donor's blood circulating, once death is certified, to keep the organs oxygenated, followed by a static cold preservation of the graft. If the heart is in adequate condition, it is implanted like a brain-dead donor heart transplant.

The results are comparable and there are no significant differences. "The criteria necessary to be able to extract and later implant these hearts are very strict, specific and controlled", highlights Dr. Fabrizio Sbraga, cardiac surgeon at Hospital de Bellvitge. The Bellvitge Hospital transplant coordination team, in addition to being endorsed by the results and long experience in donation, has had the support of professionals from the Royal Papworth Hospital in the United Kingdom, a center that counts more than 100 interventions of this type since the start of his heart transplant program with donors in controlled asystole in 2015. "This is a complex type of donation, for which our hospital is the only one that is currently prepared in Catalonia", highlights Dr. Nicolás Manito, director of the non-asystole donation programs.

Asystole donation has not stopped growing both in Catalonia and in the rest of Spain since the first valid donors were obtained in 2013. In fact, as is known, it is responsible for the large increase in donation observed in recent years, which places Spain close to 50 donors per million population. In Catalonia the progression has been similar, with an activity that has been surpassed year after year, as experience was gained, more donors were obtained, and more health centers were launching their own controlled asystole donation program. In 2020, controlled asystole donors (126) already represented a third of all valid donors (378) obtained in Catalonia. However, although asystole donation is an important source of kidneys and, to a lesser extent, of livers, lungs and even pancreas, the Achilles heel of this type of donor is the effectiveness of the extraction.

Although, once the organ is removed, the implantation percentage is similar (81.7% in brain death and 80.4% in death in asystole), the extraction rate is 3.7 in brain death and only 2 , 5 in asystole death. Optimizing, as far as possible, these effectiveness rates with better extraction techniques and increasing the procurement of other organs are two of the challenges of donation in controlled asystole, in order to achieve greater availability of organs without affecting the result of transplants.

More donors means more transplants

During 2020, Catalan hospitals carried out 999 transplant interventions, 23% less than in 2019 due to the COVID-19 pandemic, according to OCATT data. In this sense, Dr. Jaume Tort, director of the OCATT, highlights that “despite the intense transplantation activity, as of December 31, 2020, 1,073 people were still waiting for an organ in Catalonia, so progress such as the one that today we present they are very necessary ”.

Without donors, there are no transplants

Bellvitge Hospital, OCATT and the Department of Health want to highlight the generosity and solidarity of donors and their families, who, thanks to their altruistic gesture, give a gift of life and hope to many people who were waiting for it. . Likewise, they recognize the work of all health and non-health professionals linked to the donation and transplantation process who decisively contribute to the achievement of these excellent results in Catalonia. And they remind you that becoming a donor is as simple as deciding your willingness to be a donor and sharing it with your family and friends.

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