(Don’t) Be Still My Heart

It’s a classic medical drama scene: a lab-coated doctor bursts through the swinging doors of the surgery room, Old West saloon style.  In his white-knuckled hand, he grasps a small, white foam cooler.  The camera zooms in on a speckle of blood on his sleeve overlooked in his rush to scrub up.  Then it cuts to the ticking clock on the wall.  The doctor is running out of time.  If he doesn’t hurry, the heart on ice in the cooler will die, and so will the patient waiting for the transplant.

The most surprising thing about this high-drama, low-tech scene?  It’s real.  Despite years of transplants, this Hannibal Lecter-style use of the ordinary picnic cooler has been the standard since the first U.S. heart transplant was performed in 1967.  But it may not be this way for much longer.  Right now, researchers are the University of California, Los Angeles are gearing up for a study in collaboration with several other schools that will be following 128 patients worldwide to compare the safety and effectiveness of the old method to a newer approach. In this “beating heart” transplant, developed four years ago, the organ is attached to a high-tech, portable machine that pumps blood through it, keeping it beating while it makes its journey to the anxious patient.

Normally, the heart chosen for transplant is injected with potassium chloride, which stops it from beating, and then removed from the donor’s body.  From there, it has to be rushed to the transplant patient, as it can only stay fresh for about four to six hours.

Because of this short shelf life, transplants are severely limited by location.  Hearts are given first to people on the waiting list who live near the donor’s hospital, not those who have been waiting the longest.  Doctors think that the longer the lag time between donor and recipient, the greater the patient’s chances of death or heart disease.  Doctors hope that “beating hearts” could last for much longer—maybe up to 24 hours—and would suffer less damage in their journey to a new chest cavity.

The first successful “beating heart” transplant took place in 2006, at the Bad Oeynhausen Clinic for Thoracic and Cardiovascular Surgery in Germany.  Now, about 2,000 heart transplants (the vast majority done the traditional way) are done every year.  But more than 3,000 people are on the waiting list at any given time.  Almost one person per day dies while waiting for a new heart.

Doctors hope that this new technique could help increase the number of hearts available. Now, only hearts deemed to be in perfect condition are transplanted, and there aren’t many of those around that don’t already have an owner.  The hope is that if the heart is kept beating, rather than suffering the rigors of cooling, reheating, and defibrillation to start it up again, it will be in good enough condition that even a less-than-perfect heart will be transplantable.

If the new study shows that the new kind of transplant is successful, more patients may get the hearts they’re so desperately waiting for.  And foam coolers may never again be filled with anything more remarkable than sandwiches and beer.  Here’s hoping.