Sasha-Ann Simons: TV shows. They tend to exaggerate the present, but life is imitating art this week. And by art we just mean Grey's Anatomy.

ARCHIVE GREY'S ANATOMY: Oh man, whoever talks about this thing like it's a magic eight ball, it's a heart in box. When you take an organ transplant, what do you do? Put it on. You put it on ice and run to place it in the recipients body and then you wait and hope for this cold, dead heart to warm up and come back to life. Right? But she she has never...

Sasha-Ann Simons: That scenario became a reality for surgeons at Northwestern Medicine's Bloom Cardiovascular Institute, their team performed the state's first transplant of a heart donated after circulatory death, which we'll explain in a moment. The new procedure known as "heart in a box" could save countless lives. And here to explain is Dr. Jane Wilcox, she leads heart failure treatment and recovery at Northwestern Medicine Bloom, Cardiovascular Institute. Welcome Doctor.

Jane Wilcox: Thanks so much Sasha, it's great to be with you.

Sasha-Ann Simons: So this is the first heart transplant of this kind to happen in Illinois. How's it different from the norm?

Jane Wilcox: That's correct. So traditionally, heart transplants that we've been doing for the last, you know, 30, 40 years come from organ donors who've been declared brain dead, following usually a catastrophic event like traumatic brain injury or a drug overdose. But their hearts, their lungs, their livers, their other organs, remains beating, usually with mechanical assistance. With donation after circulatory death, a donor experiences similar events. But with really no chance of recovery. But they don't meet strict criteria for brain death. There's a lot of strict criteria. 

So instead, the death is declared when their heart and their lungs shut down, either naturally or because we withdraw life sustaining care. And we only have about 30 minutes to then procure the heart. But because the heart is, you know, it stopped beating, we need to ensure that the heart will, you know, beat again, if we put it in a donor. And so this organ care system or "heart in a box" allows us to, you know, reanimate the heart, stimulate the heart to start beating again. And it simulates the environment inside the body. So it's warm, it's perfused with, you know, bright red oxygenated blood that's from the donor. And it allows us to, you know, it extends our period of time that we can get to our recipients. And that's, that's what we did for Mr. Dorsey about two weeks ago. 

Sasha-Ann Simons: Interesting. So this heart in a box, I'm still trying to imagine what it looks like. Is it on a pillow? Is it maybe suspended in some kind of liquid 

Jane Wilcox: So, it's suspended, It's, it's it's attached to sort of tubes that go into the arteries, but it really looks like a Tupperware container. A fancy Tupperware container.

Sasha-Ann Simons: Wow.

Jane Wilcox: But it's, it's clear. There's a non sterile membrane that you can actually put your hands against, and feel the heart beating, which as you can imagine, is a really surreal feeling. But it's, it's a heart in a clear box, and it's actively beating, and it's sort of resting on a support device. 

Sasha-Ann Simons: Wow. Have you seen that Grey's Anatomy episode, by the way?

Jane Wilcox: I was listening to that before we got on. I have not seen that particular episode. But I am historically a Grey's Anatomy fan.

Sasha-Ann Simons: So the patient, how is he doing now? Any complications?

Jane Wilcox: No, he's doing great. He's doing fantastic. And he, I don't think would have been transplanted, you know, this this quickly with traditional methods. So he's really grateful to be sort of the first in Illinois, and he's doing fantastic. He's actually going home this week.

Sasha-Ann Simons: Wow. That's incredible. And I think still, Dr. Wilcox, a lot of us are trying to wrap our minds around this seeming miracle, right? How do doctors determine if a heart is eligible to donate?

Jane Wilcox: There's so... It's a very resource intensive field. We number one, have to make sure that the blood type matches, there are other things like size and considerations as well as something called antibodies. So making sure that all of those things match up. And then we go procure the heart and have to make sure that the function that we saw from non invasive testing, you know, something called echocardiograms, ultrasounds, X rays, things like that, that all matches up when we get to the location of the donor. And at that point, we make the decision to go ahead, procure the organ. And then the clock is really ticking. So the heart traditionally goes on ice and the stopwatch starts. And we have usually less than four hours to get that heart back to the hospital back inside and pumping into the recipient. So a lot of things can come up. 

Sasha-Ann Simons: So four hours to move the heart from one person's body to this device. Or at least to the other....

Jane Wilcox: Oh, sorry four hours traditionally to the recipient.

Sasha-Ann Simons: To the recipient.

Jane Wilcox: With the heart in a box that extends up to nine hours or so it's about double the time of a traditional transplant. And so that really allows us: to go further distances, manage logistical issues, like in Chicago, snowstorms, traffic, fog, things like that, that come up when we are flying to, to, you know, distant locations to get our hearts.

Sasha-Ann Simons: This is Reset. I'm Sasha-Ann Simons If you're just tuning in, we're talking with Dr. Jane Wilcox of the Northwestern Medicine Bloom Cardiovascular Institute, about the state's first transplant of a heart that was donated after circulatory death. And just to be clear, doctor, when we talk about circulatory death, we're talking about when the heart stops beating, is that correct?

Jane Wilcox: Correct. Correct. So a patient has suffered traumatic brain - irreversible brain injury, but is not, sort of, meets the correct strict criteria for brain death. And so life support is withdrawn, the heart stops, the patient is declared dead. And at that point, we can procure the heart. And this comes up a fair amount where families want to honor their loved ones wishes, but they haven't met strict criteria for brain death.

Sasha-Ann Simons: You talked a moment ago about how this heart in a box really expands the lifespan of that heart outside of a body. Explain why that is so important.

Jane Wilcox: It's incredibly important because we're, we're on the clock. As soon as that heart goes into a cooler traditionally, or the heart is no longer beating it, it starts to undergo irreversible tissue damage. And so by creating an environment that simulates the body, we can extend that period of time, up to 9, 10 hours, so that we can, you know, get back to where we are, you know, at Northwestern Medicine, and it allows, you know, just it allows so much more time to deal with these logistics that come up during transplant. Like the snowstorm, like the fog, like the you know, patient making sure that they're at the hospital, they're ready to go. All of those things, give us a little bit of a buffer and allow us potentially to increase the ability to do our transplants across the US by about 30%.

Sasha-Ann Simons: Yeah, so these hearts are traveling all across the country.

Jane Wilcox: Correct, correct. And we have a huge supply demand mismatch problem in the United States, when we when it comes to heart transplantation. We have, you know, over 7,000 people who are are listed for heart transplant at any given time, and only 3,500 hearts, or 3,500 patients receive a heart transplant. And so with this organ, ex vivo perfusion system, it really expands the donor pool. And it allows, you know, for more patients, potentially, to get a life saving transplant.

Sasha-Ann Simons: And I imagine Dr. Wilcox, you've been doing this this work for some time. Did you ever imagine that we'd get here?

Jane Wilcox: You know, yes and no. I went into to transplant medicine to heart failure and recovery, because there was so much hope and so much technology. Did I think it would come this quickly? Probably not. But it's really, really nice to be here. And and celebrate this win. 

Sasha-Ann Simons: And it was first used the technology on a heart back in 2020 in this country. How come it's just now happening in Illinois?

Jane Wilcox: Good question. So there have been - there was a clinical trial that we had to sort of prove that this this device, this heart in a box, you know, was not inferior to our traditional methods of transplantation. As physicians, we take a first do no harm oath. And after we saw the data and saw that, you know, this actually does improve the longevity of the donated heart and allows us to travel further distances and outcomes are similar. I think this technology will definitely expand to other transplant centers across the country.

Sasha-Ann Simons: I understand the tech around heart in a box that it's been used for other organs besides hearts by this point?

Jane Wilcox: Yes, yes, it has been used in livers and kidneys as well. It hasn't, you know - heart transplantation is often the last to adopt a new technology. Because kidney failure leads to dialysis. Heart failure leads to death. And so we really, really have to be sure that when we are dealing with something related to a heart, that we get it right 100% of the time, because the the downside or the risk of things not working out is not, you know, dialysis, organ failure, it's death.

Sasha-Ann Simons: Has the success rate been good when it comes to livers and kidneys? In a box? 

Jane Wilcox: Absolutely. Absolutely. And so we are now we are now adopting this technology. And I think it's really just a really exciting time.

Sasha-Ann Simons: How many people do you think are waiting on organs today, Doctor?

Jane Wilcox: So you can look at the United Network for Organ Sharing website and see, you know, the number of patients who are waiting for liver transplant for kidney transplant for heart transplant. You can see the patients who have received a heart transplant or who are waiting. And that number is about 3,500, who are being added to the list every year for heart transplant, in addition to the 3,500, who received a heart transplant. So in flux, that adds up to about 7,000 patients who need what we call advanced therapies advanced heart transplantation per year. And when we think about also the number of patients who are, are eventually going to need a heart transplant, that number has gone up by 10 to 20% each year. So the demand is rising. And so this technology we need, we need big game changing events like this to keep up with the demand.

Sasha-Ann Simons: It's also striking me that an estimated 70% of donor hearts go unused each year.

Jane Wilcox: Yeah. Yeah, it's crazy. So it's not because we're not trying. It's because we you know, you you get an offer of a donor. And it's just too far that four hour window is too long. You have someone who is listed for transplant, their blood type, their antibodies, their size, all of those things have to sort of match up. And so if they don't match up and you don't have the luxury of time, unfortunately, those traditionally those donor hearts would go unused. With this OCS heart in a box My hope is is that we can actually use about 30% more of those hearts simply because we, we have better logistics, and we have the ability to go long, go further distances and plan for those those patients.

Sasha-Ann Simons: Fascinating stuff. Dr. Jane Wilcox leads heart failure treatment and recovery at Northwestern Medicine Bloom Cardiovascular Institute. Thank you for joining us.

Jane Wilcox: Thanks so much Sasha. Have a great day. 

Sasha-Ann Simons: You too.

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