The “Heart-in-a-Box” device revolutionizes organ transport

When organ transplants became a more common procedure in the 1950s and 1960s, the standard method of transporting organs was to pack them on ice in a cooler no more fancy than the one you might use to pack drinks. for a picnic.

These coolers limited travel time to maintain a viable organ for transplantation—for a heart, that window was about four hours—which severely limited the distance a donated organ could be retrieved and transported. Additionally, organs transported to cold storage could be “freezer burnt” because the temperature in the cooler was unregulated.

It remained the usual means of transporting organs until just a few years ago, when dramatic improvements were made to the process of transporting organs from donors to recipients. After many years of clinical trials, some of which were conducted at Duke, the U.S. Food and Drug Administration has approved the use of a superior device: a battery-powered vessel that keeps the organ in operation, perfusing it with warm, nutritious water and oxygen-rich blood, using wireless technology to monitor the organ and allow for longer transport time. TransMedics created and received approval for the “TransMedics OCS^MT (Organ Care System)”, which is currently available for hearts, lungs and livers. FDA approval was obtained separately for Transmedics devices for each organ: lungs in 2018, heart in 2021, liver in 2022

The heart device is sometimes called a “heart in a box”, but it’s not really a box. It has a plastic chamber in a nearly 100-pound rolling cart that holds the donor’s heart, connected to tubes that pump drugs, nutrients and blood through it. The heart continues to beat all the time during transport from the donor to the recipient, and its condition is constantly monitored. The device contains batteries for up to 10 hours of use, but it can also be plugged into an electrical outlet. The electricity powers the oxygenator and a heater to keep the heart chamber at the right temperature, as well as the monitoring system.

“These devices extend the life of organs once they are removed from the donor and introduce more flexibility into the system.”
-Stuart Knechtle, MD, HS’82-’89

By keeping organs in better condition for longer, hot infusion devices allow procurement teams to travel greater distances to retrieve organs and greatly extend the length of time donor organs can be kept viable. And by monitoring the organ during transport, the device allows surgeons to better understand its condition. All of this makes more organs available for transplant – a crucial step forward, as currently more than 100,000 people are on transplant waiting lists in the United States, and an average of 17 people die each day while waiting for a transplant. .

In 2019, Duke University Hospital, in a clinical trial, was the first institution in the United States to successfully use a Transmedics device for a “DCD” – donation after circulatory death – heart transplant.

“These devices extend the life of organs once they are removed from the donor and introduce more flexibility into the system,” said Stuart Knechtle, William R. Kenan Jr. Professor Emeritus of Surgery and Director of the Duke Transplant Center. . “He’s a real game changer.”

Learn more about Duke’s organ transplant program
and alumni who make a difference in this area:

Duke’s Organ Transplant Program: Out With the Old, In With the New

Alumni making a difference: David Axelrod, MD’96, MBA’96

Alumni make a difference: Roslyn “Roz” Bernstein Mannon, MD’85, HS’85-’90

Article originally published in DukeMed Alumni News, Spring 2023.

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