- Press Release Distribution

Maintaining heart function in donors declared ‘dead by circulatory criteria’ could improve access to heart transplantation

( More donated hearts could be suitable for transplantation if they are kept functioning within the body for a short time following the death of the donor, new research has concluded.

The organs are kept functioning by restarting local circulation to the heart, lungs and abdominal organs – but, crucially, not to the brain – of patients whose hearts have stopped beating for five minutes or longer and have been declared dead by circulatory criteria (donation after circulatory death, or DCD).

It is hoped that this technique could increase the number of usable donated hearts by as much as 30% in the future, helping address the shortage of transplant organs. In 2021, 8,409 heart transplants were reported to the Global Observatory on Donation and Transplantation (GODT) by 54 countries. This activity is in contrast with the 21,935 patients who were on a heart waiting list during the year 2021, of whom 1,511 died while waiting and many others became too sick to receive a transplant.

John Louca, a final year medical student at Gonville & Caius College, University of Cambridge, and the study’s first author, said: “Heart transplants are the last bastion for patients with end-stage heart failure. They are successful – patients who receive a transplant live on average a further 13 to 16 years. The biggest problem they face is actually getting access to a donated heart: many patients will die before an organ becomes available. That’s why we urgently need to find ways to increase the suitability of donor organs.”

Though the first heart transplant performed at the Groote Schuur Hospital in Cape Town (South Africa) in 1967 was obtained from a DCD donor, this technique was abandoned and replaced by heart transplants obtained from donors confirmed dead using neurological criteria (donation after brain death, or DBD) – in other words, their brain has stopped functioning entirely.

Until recently, heart transplants worldwide were still performed only with organs obtained from DBD donors. However, in recent years, heart transplants from DCD donors have become a clinical reality worldwide thanks to years of research carried out in Cambridge.

DCD is the donation of organs by patients who tragically have a non-survivable illness. These patients are typically unconscious in intensive care in hospital and dependent on ventilation. Detailed discussions between doctors, specialist nurses and the patient’s family take place and if the family agree to organ donation, the process starts.

After treatment is withdrawn, the heart stops beating and it begins to sustain damage to its tissues. After 30 minutes, it is thought that this damage becomes irreversible and the heart unusable. To prevent this damage, at the time of death these non-beating hearts are transferred to a portable machine known as the Organ Care System (OCS) where the organ is perfused with oxygenated blood and assessed to see whether it is suitable for transplantation.

This technique was pioneered by Royal Papworth Hospital NHS Foundation Trust in Cambridge, whose transplant team carried out the first DCD heart transplant in Europe in 2015. Royal Papworth has since become the largest and most experienced DCD heart transplant centre in the world.

DCD heart transplantation started simultaneously in Australia, followed by Belgium, The Netherlands, Spain and USA. According to the GODT, 295 DCD heart transplants were performed in these six countries in 2021.

Organ Care Systems are expensive, costing around US$400,000 per machine plus an additional $75,000 for consumables for each perfused organ. An alternative, and much more cost-effective approach, is known as thoraco-abdominal normothermic reperfusion (taNRP). This involves perfusing the organ in situ in the donor’s body and is estimated to cost around $3,000. Its use was first reported in 2016 by a team at Royal Papworth Hospital.

In a study published in eClinical Medicine, an international team of clinical scientists and heart specialists from 15 major transplant centres worldwide, including the UK, Spain, the USA and Belgium, looked at clinical outcomes of 157 DCD donor hearts recovered and transplanted from donors undergoing taNRP. They compared these with the outcomes from 673 DBD heart transplants, which represents the ‘gold-standard’.

The team found that overall, the use of taNRP increased the donor pool significantly, increasing the number of heart transplantations performed by 23%.

Mr Stephen Large, Consultant Cardiothoracic Surgeon at Royal Papworth Hospital and chief investigator, said: “Withdrawing life support from a patient is a difficult decision for both the families and medical staff involved and we have a duty to honour the wishes of the donor as best we can. At present, one in ten retrieved hearts is turned down, but restoring function of the heart in situ could help us ensure more donor hearts find a recipient.”

Survival rates were comparable between DCD and DBD heart transplantation, with 97% of patients surviving for more than 30 days following taNRP DCD heart transplant, 93% for more than a year and 84% of patients still alive after five years.

Professor Filip Rega, Head of Clinic at the Department of Cardiac Surgery, UZ Leuven, Belgium, said: “This promising new approach will allow us to offer heart transplantation, a last resort treatment, to many more patients in need of a new heart.”

The researchers say that some of the benefits from taNRP are likely thanks to the reduced amount of time the heart was not receiving oxygenated blood, known as its warm ischaemic time, when compared to direct procurement (that is, when the heart is removed immediately for transplant, and perfused outside the body). The median average time was 16.7 minutes, significantly less than the 30 minutes associated with permanent damage to the heart cells.

An added benefit to this approach is that it allows medical teams to simultaneously preserve several organs, such as the liver, pancreas and kidneys, without the need of several organ-specific external machine perfusion devices. This decreases complexity and costs.

Professor Ashish Shah, Head of the Department of Cardiac Surgery at Vanderbilt University Hospitals, Nashville, USA, said: “Heart transplantation has been and always will be a uniquely international effort. The current study is another example of effective international collaboration and opens a new frontier, not just in transplantation, but in our basic understanding of how all hearts can be rescued.”

Dr Beatriz Domínguez-Gil, Director General of the National Organisation of Transplantation in Spain, said: “The results of this collaborative study bring hope to thousands of patients in need for a heart transplant every year throughout the world. Its findings reveal that DCD heart transplantation based on taNRP can lead to results at least similar to the gold standard and increase hearts available for transplantation in a manner that contributes to the sustainability of health-care systems.”


Louca, J et al. The international experience of in-situ recovery of the DCD heart: A multicentre retrospective observational study. eClin Med; published online 2 March 2023; DOI: 10.1016/j.eclinm.2023.101887



Not enough new antibiotics in the pipeline, concludes WHO review – especially those targeting deadly drug-resistant microbes

**Note: the release below is a special early release from the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2023, Copenhagen, 15-18 April). Please credit the congress if you use this story** Embargo – 2301H UK time Wednesday 15 March A review from WHO on the number of new antibiotics currently in the pipeline shows that just 12 new antibiotics have entered the market in the five years from 2017-21.  And there are far too few (just 27) under development in clinical trials against pathogens considered critical* by WHO such as Acinetobacter baumannii and Pseudomonas aeruginosa. ...

Short night-time sleep linked with nearly doubled risk of clogged leg arteries

Sophia Antipolis, 16 March 2023:  Sleeping less than five hours a night is associated with a 74% raised likelihood of developing peripheral artery disease (PAD) compared with seven to eight hours. That’s the finding of a study published today in European Heart Journal – Open, a journal of the ESC.1   “Our study suggests that sleeping for seven to eight hours a night is a good habit for lowering the risk of PAD,” said study author Dr. Shuai Yuan of the Karolinska Institute, Stockholm, ...

New global ranking for life expectancy shows decades-long UK decline

A new analysis of global rankings of life expectancy over seven decades shows the UK has done worse than all G7 countries except the USA. Researchers writing in the Journal of the Royal Society of Medicine say that while UK life expectancy has increased in absolute terms over recent decades, other, similar countries are experiencing larger increases. In 1952, when Queen Elizabeth II came to the throne, the UK had one of the longest life expectancies in the world, ranking seventh globally behind countries such as Norway, Sweden and Denmark. ...

Humans are altering the diet of Tasmanian devils, which may accelerate their decline

The Tasmanian devil roams the island state of Australia as the apex predator of the land, feeding on whatever it pleases as the top dog – or the top devil. But some of these marsupial scavengers could be starting to miss out on a few items from the menu. According to a study led by UNSW Sydney, living in human-modified landscapes could be narrowing the diet of the Tasmanian devil. The research, published recently in Scientific Reports, suggests devils have access to vastly different cuisines depending on the type of environment they live in. “We found Tasmanian devil ...

Utah’s graphics pioneers

They were a group of young, scrappy, but brilliant University of Utah computer science students and professors who changed the world. Ed Catmull. John Warnock. Jim Clark. Alan Kay. Ivan Sutherland. Martin Newell. They are a just a handful of the luminaries in the late 1960s and 1970s who revolutionized computer graphics by inventing technologies that have aided and shaped countless industries today. For the first time ever, these and other legends of that time will be reuniting on the U campus Thursday, March 23, and Friday March 24, to commemorate their roles as ...

Humans are not just big mice: Study identifies science’s muscle-scaling problem

CHICAGO — March 16, 2023 — In science, findings generated from studying small animals often are generalized and applied to humans, which are orders of magnitude larger. New research, which was led by Shirley Ryan AbilityLab and will be published in a forthcoming issue of the Journal of Physiology, not only is the first to directly measure human muscle contractile properties; it also is the first to show that extrapolating such information to humans based on animal measurements generates incorrect predictions. The discovery occurred initially when researchers leveraged a unique surgical technique in which a human patient’s ...

U.S. opioid crisis best viewed as a connected ecosystem

The nation’s opioid crisis, which kills thousands of Americans annually, is best viewed as an ecosystem where all parts of the vexing problem are interconnected, underscoring the need for holistic solutions that address the broad needs of those battling addiction, their families and the communities where they live, according to a new report from the nonprofit RAND Corporation.   Too often different actors in the ecosystem focus primarily on addressing just one part of the problem, with each component of the system having its own priorities and initiatives ...

Trust in cancer information declined among Black Americans during the pandemic

Trust in information given out by the government on cancer fell sharply among the Black population, by almost half, during the COVID-19 pandemic findings of a national US study have shown.  Experts are warning the vital need to monitor if this mistrust has persisted beyond the pandemic and whether it could potentially cause an upsurge in late or fatal diagnoses – following a lack of uptake of important cancer prevention measures such as routine screening and human papilloma virus (HPV) vaccinations.   The findings, published today in the peer-reviewed ...

OMG, texting intervention prevents teen pregnancy among lesbian and bisexual girls

A new texting intervention that University of British Columbia researchers helped develop is more effective at promoting healthy sexual decision-making and reducing pregnancies among sexual minority teens than most existing interventions in the U.S. Girl2Girl, developed and tested by the Center for Innovative Public Health Research (CIPHR) in San Clemente, Calif., in partnership with UBC’s Stigma and Resilience Among Vulnerable Youth Centre, is the first texting-based intervention specifically aimed at lesbian and bisexual teens. “For more than 30 years, research ...

Employees tend to avoid taking breaks despite high levels of stress

Heavy workloads make employees feel a greater need for a break, but new research finds they may actually discourage employees from taking breaks at work despite causing high levels of stress, fatigue, and poor performance. Researchers from the University of Waterloo found employees often kept working despite wanting to pause. One potential reason is employees may have felt pressure to continue working to get everything done on time.  “Our research provides a comprehensive account of the processes involved in the decision to take a break and provides insights into how employees and managers can make more effective use of breaks at work, ...


A unified account of Darwinism’s varieties

Marketers can manage 'feature creep'

Intermittent fasting shows promise in improving gut health, weight management

Scientists identify gene that could lead to resilient ‘pixie’ corn

Utilizing medical assistants to manage patient portal messages shown to support practice and physician efficiency

Study shows clinic continuity associated with reduced hospital and emergency visits

Recognizing the range of experiences among individuals of Latino, Hispanic, and/or Spanish origin is an essential step toward health equity

study reveals decline in reported medicare outpatient procedures by family physicians amid an aging population

COVID-19 pandemic leads to drop in breast cancer screenings, especially among older and racial minority women

Translating the Surgeon General’s framework on social isolation and loneliness to actionable steps in primary care

Point/counterpoint: Is prediabetes overdiagnosed?

Primary care clinics can help low-income families receive nutritional support benefits

The wall of evidence for continuity of care

Parents of children with serious illness from Somali, Hmong, and Latin American communities desire better communication and support in pediatric health care

Primary care can improve hygienic practices while reducing waste

HKUST researchers enhance performance of eco-friendly cooling applications by developing sustainable strategy to manipulate interfacial heat transfer

Variations in medical assistant to primary care clinician staffing ratios may reflect differences in practice ownership and organizational culture

Better disciplinary structures in schools can help reduce hate speech directed against Asian American students

Bringing back an ancient bird

Wistar research identifies mechanisms for selective multiple sclerosis treatment strategy

Fatherhood’s hidden heart health toll

The importance of integrated therapies on cancer: Silibinin, an old and new molecule

Texas A&M-led team creates first global map of seafloor biodiversity activity

Light therapy increases brain connectivity following injury

Power imbalance in health care reveals impact of race and role on team dynamics and DEI efforts

NRG Oncology appoints new vice-chairs for their patient advocate committee

Why do Dyeing poison frogs tap dance?

UC Irvine study reveals circadian clock can be leveraged to enhance cancer immunotherapy

Cell-targeting technology allows researchers to isolate neuronal subpopulations and link them to behavioral states

When should you neuter or spay your dog?

[] Maintaining heart function in donors declared ‘dead by circulatory criteria’ could improve access to heart transplantation