Yashutosh Joshi surgery

Heart in a Box's global impact

World-first transplant discovery giving hope to patients around the world

6 September 2022

The number of successful heart transplants has soared by a quarter at St Vincent’s Hospital, Sydney, since the introduction of the world-first technology of the 'Heart in a Box', pioneered by the Victor Chang Cardiac Research Institute and St Vincent’s.

New research published in Transplantation has revealed the technique, which allows surgeons to transplant donor hearts that have stopped beating after death (also known as DCD hearts), has not only reduced waiting lists in Australia but also potentially around the world.

The first DCD heart transplant performed in 2014 represented a paradigm shift in organ donation. Until then patients relied solely on donor hearts from brain-dead patients whose hearts were still beating at the time of retrieval.

Dr Yashutosh Joshi says he expects the number of transplants to increase even further after research revealed survival outcomes were just as successful for those who received DCD hearts as those who received hearts from traditional brain-dead donors.

“Previously, donor hearts from a DCD pathway were not able to be used. In the last eight years we have now been able to retrieve these hearts and increase the donor pool which has had a positive impact on our waitlists with more heart transplants being performed than before. That figure will only increase giving hope to patients across the country who are desperately in need of a new heart, sometimes even at death’s door,” says Dr Joshi, St Vincent’s Hospital cardiothoracic registrar and lead author of the paper.

DCD transplants allow hearts to be donated from patients who have died after withdrawal of life support and in whom death is declared only after the heart has stopped beating. This is achieved by using a defined preservation fluid developed in the laboratory and a machine that allows the heart to beat outside the body known as ‘Heart in a Box’ which allows the organ to be reanimated and assessed.

Illustration of 'Heart in a Box' technology

Illustration of 'Heart in a Box' technology

Since 2014, 74 DCD transplants have been performed by the team at St Vincent’s.

Professor Peter Macdonald, who led the team that pioneered DCD heart transplant surgery says: “Around the world, there are now hundreds of people who have received DCD hearts. Our discovery has been life-changing and lifesaving for so many patients.”

Professor Macdonald, of the Victor Chang Cardiac Research Institute and senior cardiologist at St Vincent’s Hospital, adds:

“Since 2014 our team of scientists and surgeons have worked tirelessly to ensure outcomes are every bit as successful with this new technology. Now that this has been achieved and proved, we expect many more heart transplant teams around the world to embrace this technology.”

Initially, it was found that hearts retrieved from DCD donors took a lot longer to recover after transplantation. Initially around a third of patients had to be placed on a machine similar to heart-lung bypass for a short period of time to allow the newly transplanted heart to recover. However, the team from the Institute and the hospital has since worked out how to better protect DCD hearts during retrieval and transport, drastically reducing the need for this with only a small percentage now requiring temporary bypass.

Going forward, the team is now looking at ways to extend the period of time hearts can survive without circulation prior to transplantation.

Whilst the team at St Vincent’s Hospital in Sydney is the only one in Australia which can perform DCD transplants, its transplant team travels the country to retrieve suitable donor hearts by using the ‘Heart in a Box’ machine.

DCD Heart transplantation is now being carried out in the US, Spain, Belgium, the Netherlands, and the UK, where close to half of all transplants are now with DCD hearts.

Dr Yashutosh Joshi is a recipient of a Heart Foundation PhD Scholarship.

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Male patient in hospital bed after heart surgery

"I never thought I would have this quality of life after a transplant"

- Ross Tripodi, DCD heart recepient

Acknowledgement of Country

The Victor Chang Cardiac Research Institute acknowledges Traditional Owners of Country throughout Australia and recognises the continuing connection to lands, waters and communities. We pay our respect to Aboriginal and Torres Strait Islander cultures; and to Elders past and present.

Victor Chang Cardiac Research Institute - The Home of Heart Research for 30 Years