29-year-old Sanjana Kochhar from Newcastle upon Tyne was the first patient in the UK to receive a donor heart transported via a new method, called the XVIVO Heartbox. It is hoped that the new method could improve heart function after surgery, and increase the number of successful transplants.
Usually, donor hearts are preserved during transport by being placed in a cold solution and stored in an icebox at around four degrees. This method preserves the heart for less than four hours and the success of a transplant operation relies heavily on the organ arriving within this short timeframe.
Unfortunately, up to 20% of donor hearts may not function effectively after transplant, leading to some patients becoming poorly and needing intensive care after surgery.
As part of a European clinical trial, the Institute of Transplantation, based at the Freeman Hospital, is one of three sites in the UK and one of fifteen European sites trialling the XVIVO Heartbox.
The Heartbox is a portable machine perfusion device with a special pump that is connected to the donor heart. The pump delivers a solution containing oxygen and nutrients to the heart during its journey to the hospital. As the heart is still and cold, it consumes less oxygen and loses less energy, helping to keep it in better condition.
Last remaining option
Professor Stephen Clark, consultant cardiothoracic surgeon at Newcastle Hospitals, said:
“During transportation, it is vital that the heart is preserved at a certain temperature so that we have the best chance of a successful transplant.
“The logistics of transporting a heart within a short timeframe are incredibly complex, and unfortunately, in some cases, donor hearts do not function well after transplantation.
“For some of our patients with heart failure, a heart transplant is one of the last remaining treatment options when all others have been unsuccessful. The trial of this new machine allows us to explore an entirely new method of heart preservation where the heart is kept still, cool and perfused with an oxygenated solution mixed with blood throughout its journey.
“We hope this method helps the heart to function better and be able to be stored for longer than is the case now. Such innovations are vital if we are to save our patients lives through heart transplant and give them a longer, better quality of life.
“We are very proud to have been the first unit in the United Kingdom to use this exciting technology and continue our research partnership with several heart transplant units around Europe.”
The success is thanks to a collaborative effort from the cardio and transplant clinical teams such as the perfusionists, theatre and intensive care unit teams, and transplant coordinators, alongside the cardiology and transplant research team.
Nationally, the study is led by Mr Aaron Ranasinghe, consultant cardiac and heart/lung transplant consultant at University Hospitals Birmingham NHS Foundation Trust. He said:
“It has been wonderful to see the collaborative working between UK and European transplant centres as part of this trial which is extremely important for both the UK and worldwide transplant community.
“Congratulations to the Newcastle team for performing the first transplant in the UK with this technology.”
Saving more lives
Christoffer Rosenblad, CEO of XVIVO, added:
“We are thankful for the support from patients and clinical trial investigators in the UK who choose to participate in the ongoing clinical trial. XVIVO’s investigational heart technology is currently being evaluated in clinical trials in Europe and Australia, and soon the US, in order to seek regulatory approvals for commercialization. We believe that the new innovative heart technology from XVIVO has the potential to change the paradigm in heart preservation as it will open up for using more available hearts, and in turn saving more lives.”
Emma Lawson, organ and tissue donation research and innovation lead at NHS Blood and Transplant, added:
“Currently in the UK, the majority of hearts offered but not accepted for transplantation (and therefore not retrieved), are declined due to unsuitability of the donor or the organ itself. With more than 300 people currently waiting for a heart transplant, this significantly outweighs the number of suitable donor organs. It is vital that we continue to embrace all new research, innovation and techniques, to improve the chances that these desperately ill patients will get the call they are waiting for.
“We are grateful to all of those who work so hard to improve knowledge and understanding of transplantation techniques like this, but most of all the patients and families who agree to organ donation enabling us to support valuable research into saving and improving the lives of many others still waiting.”
29-year-old Sanjana Kochhar says she wouldn’t be here today if it wasn’t for the care she received at the Freeman Hospital, and ultimately the stranger who saved her life.
Sanjana was enjoying life at university when she started to experience breathlessness and heart palpitations.
Sanjana, who was 19 at the time, decided to book an appointment at her local GP practice to get checked out, but wasn’t too concerned because she had suffered with asthma when she was younger. At her appointment, a nurse carried out an ECG, a test that checks the heart’s rhythm and electrical activity.
“I wasn’t particularly worried about the symptoms I was experiencing, mainly because I was young and fit, but I thought it would be best to get checked out. I saw a nurse at my GP practice who carried out the ECG and was stunned when they told me my heart tracing was ‘grossly’ abnormal”, says Sanjana.
Sanjana, who now lives in Liverpool but is originally from Newcastle upon Tyne, was referred to the Freeman Hospital for further tests, including a cardiac biopsy which involves taking a small amount of tissue from the inner lining of the heart muscle.
Sanjana was diagnosed with cardiomyopathy, a term used to describe diseases of the heart muscle where the walls of the heart chamber become stretched, thickened, or stiff. This affects the heart’s ability to pump blood around the body, leads to heart failure and can be life-threatening.
Although Sanjana was managing her symptoms at the time, she was told by her consultant at the Freeman that she would eventually need a heart transplant.
“I think the clinicians were surprised that I was managing my symptoms so well, but I wasn’t under any illusion that the time would come when I needed the transplant. I was told that when things started to deteriorate it would happen quickly and time wouldn’t be on my side. And that’s exactly what happened.”
One night while at home in Liverpool, Sanjana started to experience severe chest pains and breathlessness. She went to accident and emergency and was admitted to a local hospital, but she was so unwell that a decision was made to transfer Sanjana by ambulance to the Freeman’s intensive care unit.
“Logically, I knew the time would come when I needed the transplant, but it all felt so surreal at the time. There are periods of time I have no recollection of – I think my mind has blanked them out.”
Sanjana suffered multiple organ failure and her condition became so severe that clinicians at the Freeman placed her on the super urgent transplant list. The care and treatment she received meant she recovered enough to be put on the urgent list in Autumn.
While waiting for a transplant, Dr Jérôme Jungschleger, cardiothoracic surgeon in heart and lung transplantation at Newcastle Hospitals, told her about a new study that the trust was running and asked if she wanted to take part.
“Dr Jungschleger told me about the Heartbox study, that Newcastle was one of three centres trialling it in the UK, and that he wanted to retrieve the donor heart and transport it in this new Heartbox.”
“To be honest, I didn’t hesitate about taking part for a moment. Having been through this experience and knowing the lifeline organ donation provides, I wanted to do anything I could to help future patients going through similar situations.”
Sanjana’s heart transplant took place in winter and was performed by Professor Stephen Clark and his team. She was the first patient in the UK to receive a heart transplant that used the Heartbox.
“Despite having had a major operation, I woke up feeling amazing and just had this feeling that I’d been part of something special. I’m eternally grateful for the second chance I’ve been given thanks to the kindness of someone donating their heart.
Sanjana continues to recover and is back to doing gentle exercising, including cycling and short, steady hikes.
“I effectively went from being bedbound and unable to dress myself to living life again. The team at the Freeman was amazing – I can’t credit them enough for essentially saving my life.”
The study is supported by the National Institute for Health and Care Research (NIHR), which supports patients, the public and health and care organisations across England to participate in high-quality research.
Professor John Pepper, NIHR National Specialty Lead for Cardiovascular Disease, said: “Heart transplants are one of the most challenging and complicated procedures for patients to receive and clinicians to perform. That’s why investing in high quality research into innovative techniques like Heartbox is crucial in investigating the potential of this new technology to preserve vital organs. We hope this will provide important evidence that can save more lives and improve outcomes for patients’ after surgery.”