‘Heart in a Box’ technology increases heart transplants by 25% in 8 years

What is the societal challenge?

Cardiovascular disease kills 17.5 million people each year globally. More deaths are attributed to it than any other disease or illness – more than any cancer, Alzheimer's, or HIV/AIDS. Each year only half the amount of heart transplants needed in Australia are performed. In 2021, 129 people received heart transplants while approximately 100 people remained on the waitlist.

How is the challenge being addressed?

Transplanting hearts that have stopped beating

UNSW Professors Peter Macdonald and Dr Yashutosh Joshi pioneered Heart in a Box technology in 2014 that allows surgeons to transplant donor hearts that have stopped beating after death, also known as donation after cardiac death hearts (DCD hearts). Previously, donor hearts from a DCD pathway could not be used for heart transplants.

DCD transplants using Heart in a Box technology allow hearts to be donated from patients who have died after withdrawal of life support and death is declared only after the heart has stopped beating. This is achieved by using a defined preservation fluid developed in the laboratory and the Heart in the Box machine that supports the heart to beat outside the body allowing the organ to be reanimated and assessed. This change to the retrieval protocol for heart transplants has resulted in a higher retrieval rate from DCD donors and fewer rejections of DCD hearts.

What are the outcomes and societal impact?

25% increase in heart transplants in 8 years
New research has revealed that since its introduction at St Vincents Hospital in Sydney in 2014, 74 DCD heart transplants have been performed, increasing the yearly average of transplants by 25%. Similar trends are expected around the globe with this technology being used across Europe and the USA.  

Successful survival rate outcomes
Dr Yashutosh Joshi, PhD candidate with UNSW Medicine & Health supported by a Heart Foundation PhD Scholarship and St Vincent’s cardiothoracic registrar, says he expects the number of transplants to increase even further after research showed 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 Yashutosh Joshi.

Whilst the team at St Vincent’s Hospital in Sydney is the only team qualified to perform DCD transplants in Australia, 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 DCD hearts transplants represent almost half of all transplants.