Transplant surgeons in UK and Australia have already started using a novel device known as “Heart in a box” which helps to “reanimate” heart from people who have died recently and then transplant them in other people thus saving their lives. In other words, it means the device is able to bring a ‘dead heart’ back to life even after it stopped beating in its original body. Well, for people who are waiting in a long queue for heart transplant this can be “great news”. However, to what extent is this transplant ethical, is a big question! One one hand we declare the original owner of the heart “dead” since it stopped working and now the same heart is revived and transplanted into some other recipient whose life is being saved by this organ. According the MIT Technology Review report the so called “heart in a box” device was developed by Massachusetts-based company, Transmedics. The device has already been used in almost 15 transplants in the UK and Australia; however it is awaiting regulatory approval in the US.
Let us try to understand the process which is currently used for heart transplants:
In the present scenario, a person awaiting heart transplant can have the heart of a vegetative or a brain dead patient, with prior consent from the patient’s family members. Right now, the heart of a deceased person is considered to be too damaged and hence cannot be used for transplantation.
Let us try to understand the process which is currently used for heart transplants:Concept of “Heart in a box” technology by Transmedics:Limitations:
The two major categories of death defined by transplant surgeons are: People can become vegetative or brain dead. Secondly, the heart and the blood flow both stop; this is also termed as “circulatory death” and in such a death by the time the heart stops it is completely deprived of oxygen and the muscles too are dying. The heart of such a person is totally damaged and it is also known as Ischemia.
In general, the heart of a vegetative person is cooled down, when the person is still alive, so that it stops gently and then it is extracted and transported in a casket which has been cooled down to 4°C. When a heart has been cooled down until 4°C, the metabolic activity tends to drops down by 90 percent which prevents the heart from deterioration and also provides enough time for the surgeon to transplant it into the body of the needy person. And by the time the heart comes back to its normal temperature and starts beating it is safe in a new body and can acquire its required supply of oxygen. Currently, this same procedure is being used for transplanting most of the organs. It is estimated that around 180 heart transplantation occurs in US using this technique every year, however this is not enough because the demand for heart transplant is very high. According to Antonio Regalado at MIT Technology Review: “In the US about 2,400 heart transplants occur each year, a figure that has remained essentially unchanged for 20 years”.
Concept of “Heart in a box” technology by Transmedics:
The novel device designed by Massachusetts-based company, Transmedics, keeps the “extracted heart” warm instead of cooling it to 4°C. This “heart in a box” device is a sterile chamber which has been fitted on a wheeled cart that has the provision of oxygen supply. The extracted ‘dead’ heart is placed in this chamber and then clamped on to tubing that continuously supplies oxygen, blood and other essential nutrients as per the requirement of the heart. The creators of this device explain that it is due to the unique design of the device which helps to revive the dead heart and keep it alive and functional for a longer time outside the body. While speaking to Chanelle Berlin at Al-Jazeera, the head of University of California, Los Angeles’ heart and lung transplant program, Abbas Ardehali said: “A human organ has never been kept alive outside of a human body until this machine became a clinical reality. It makes intuitive sense to a layperson to say, ‘Instead of having my heart on ice, I want it to be warm. I want it to be beating.’”
Limitations:
This awesome innovation definitely comes with a huge price tag of US $250,000 for one device which is too expensive. Medical ethicists have raised questions as to how long do the surgeons need to wait before removing the heart which has stopped working and considered to be dead? There are other ethical questions such as if the dead heart can be put into the machine and revived, then why not put it back in the original owner. Robert Truog, Harvard ethicist clearly says that a person who is declared dead is dead. He also told Regaldo: “How can you say it’s irreversible, when the circulatory function is restored in a different body? We tend to overlook that because we want to transplant these organs.” He further adds: “My argument is that they are not dead, but also that it doesn’t matter. They are dying and it’s permissible to use their organs. The question is whether they are being harmed, and I would say they are not.” However, Truog also added that this is entirely the call of the family, if they want to give the heart of their family member to some other needy person. According to the report of MIT Technology Review, earlier this year, surgeons at St. Vincent’s Hospital in New South Wales have reported using the Transmedics device in three cases wherein successful heart transplants were carried out. These surgeons have mentioned that they waited for less than 2 minutes before they removed it from the patient and within 20 minutes they attached the dead heart to the Transmedics rig where it was supplied with oxygenated blood and electrolytes and it started beating again. Stephen Large, a surgeon at Papworth Hospital in the United Kingdom, has already used the system successfully in eight heart transplants and believes that hearts of dead donors is too damaged to be use in absence of such a novel device. He says: “The device is vital. The heart gets an absolutely essential infusion of blood to restore its energy.” With the high-tech age the technology for revival and preservation of the vital organs is becoming more sophisticated, so it is quite interesting to understand to what extent is it ethical to declare a patient dead just on the basis of a heart that stopped beating and then within minutes extract if from the original owner and revive it just to be used by some other needful person!
