The beat goes on

Surgeons transplant hearts while they’re beating

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For the first time, a heart from an organ donor who died of cardiac arrest was restarted and then transplanted while it was beating. Initially performed by Joseph Woo, MD, professor and chair of cardiothoracic surgery, and his team in October 2022, the operation has since been used in adult and pediatric patients more than a dozen times by Stanford Medicine surgeons.

Those who have experienced brain death — not cardiac arrest — have long been the source of most heart transplants. That’s because brain death donors are kept on life support, keeping their heart beating, which helps maintain the organ’s health.

But with demand outpacing supply, the medical world has been pushed to seek new approaches. In the U.S. about 3,500 people await a heart transplant.

Recent technological advances have allowed for more success with hearts from donors who died by what’s known as cardiac or circulatory death, in which the heart has already stopped once, either naturally or because life support was discontinued.

Such procedures increase the number of hearts available for transplant, but outcomes for the recipients are poorer. These hearts have traditionally been stopped twice — first at death, then immediately before transplantation, after spending time hooked up to a device that perfuses them with oxygenated blood while outside of the body.

“Stopping the heart a second time, just before transplanting, induces more injury,” said Woo, the senior author of a study describing the beating heart procedure that published in the Journal of Thoracic and Cardiovascular Surgery Techniques in March 2023. “I asked, ‘Why can’t we sew it in while it is still beating?’”