‘Heart-in-a-box’: new heart donation method leads to many additional heart transplants

Two years ago, the first heart transplant using the 'heart-in-a-box' technique took place. Since then, nearly 60 DCD hearts have been transplanted, and the waiting list is stabilizing thanks to this promising method.

In donation after circulatory death (DCD), the stopped heart of a deceased donor is placed in a special machine. There, it starts beating again after the supply of oxygen and blood. Previously, heart donation was only possible from a brain-dead donor whose heart was still beating.

The new technique is an important step toward shortening the waiting list for donor hearts. It is the result of an efficient implementation of the new technique through close collaboration between UMC Groningen, UMC Utrecht, and Erasmus MC.

Niels van der Kaaij, cardiothoracic surgeon at UMC Utrecht:

‘Together with the Dutch Transplant Foundation (NTS) and Eurotransplant, we drew up a national protocol. Everyone on the waiting list for a donor heart was asked if they would also be willing to receive a heart via the new method. The procedures were performed in the order of the national waiting list.’

Waiting list stabilized

Following advice from the National Health Care Institute, the Ministry of Health has decided to reimburse the treatment from the basic health insurance package starting January 1, 2024. And that is good news. Because before the DCD heart donation procedure, there had been an increasing shortage of donor hearts for years, causing one in seven people on the waiting list to die. Since the arrival of DCD heart donation in the Netherlands, the waiting list has stabilized. At the end of July 2023, there were 164 people on the waiting list for a donor heart.

Michiel Erasmus, cardiothoracic surgeon at UMC Groningen:

‘Up to and including June, we have already performed 30 heart transplants in the Netherlands this year, while the norm for years was 40 per year. If we can perform close to 60 heart transplants this year, we will easily exceed that number in 2023. Hopefully, we will then also see a decrease in the number of people on the waiting list and the number of people who die before a suitable donor heart becomes available. We are already seeing a stabilization in the number of people on the waiting list, whereas it had only been growing in recent years. And the results for the recipient patients are at least as good as with the classic heart donation method.’

Advantages of the DCD heart procedure

Olivier Manintveld, cardiologist at Erasmus MC:

‘In a DCD procedure, the donor's circulation and breathing have stopped. After a five-minute “no touch” period, death is determined, and the heart is removed and placed in a perfusion machine. In the machine, the heart starts beating again after the supply of oxygen and blood.’ And that gives the surgeon more peace of mind and time to perform the operation, according to Manintveld: ‘The heart is protected in the perfusion machine. It can be stored for a maximum of eight hours before it is transplanted. The use of the machine also restores previously unusable donor hearts and makes them suitable for transplantation.’