On Aug. 11, LifeCenter Northwest, the Organ Procurement Organization for Washington, and UW Medicine’s heart transplant team together facilitated the Pacific Northwest’s first donation-after-circulatory-death (DCD) heart transplant.
The patient, Ryan Stovall, 48, a resident of Beaver Creek, Oregon, is recovering well in Seattle.
For decades, only donor hearts from patients who experienced brain death have been transplanted; hearts from patients who experienced circulatory death were deemed less predictable in terms of their long-term viability. The game-changer was technology that keeps blood and nutrients pulsing through donor hearts after recovery and during transit. It enables doctors to closely monitor the organs’ health and ensure suitability for transplant.
DCD transplants are possible when a family elects to withdraw ventilated support after death is imminent and the patient is a registered donor, or the family opts to move forward with donation. These transplants allow donors to gift more organs, so more patients’ lives can be saved.
“The recovery of this DCD heart is incredibly impactful as it is taking us to the future state of donation,” said Stacy McKean, director of organ procurement at LifeCenter Northwest. “Our team is excited to know that this is just the start of being able to save more lives.”
In this case, LifeCenter Northwest moved quickly to match the DCD heart from a Montana donor with a suitable recipient, synchronizing with UW Medicine transplant surgeons and coordinating with the team monitoring the Transmedics Organ Care System (OCS), which kept the heart beating during its trip from donor to recipient.
“The OCS allows us to measure markers of heart injury and function throughout the time that the heart is in the device. It gives us reassurance that a heart is in a good physiologic state before we transplant it,” said Dr. Maz Khorsandi, the surgeon who led Stovall’s transplant.
Research has shown that clinical outcomes of recipients of DCD hearts transported in the device have positive outcomes similar to recipients of hearts from brain-dead donors. In May the U.S. Food & Drug Administration approved the use of the OCS device with hearts donated after circulatory death.
Khorsandi recognized that DCD donation is only made possible through the generosity of patients and families.
“All transplants are limited by the supply of donor organs, so anything we can do to increase donor organs is important. LifeCenter’s efforts to have more people become donors and our efforts to accept a wider range of donor organs work in concert to serve patients like Ryan and get them transplanted sooner,” he said.
Stovall had suffered a massive heart attack in November 2021, after which his left ventricle was found to have stretched abnormally and was unable to pump blood adequately. He was fitted with two pump-assist devices, but was told he’d ultimately need a transplant. In April, Stovall suffered a stroke, which had no lasting physical effects but made him a greater priority on the heart transplant waiting list.
He credited UW Medicine and LifeCenter Northwest for his second chance at life. “I feel like if I got my care anywhere else, I wouldn’t be here right now. They’re really well-equipped to handle stuff like this up here, and it’s amazing to feel a normal heartbeat in my body again.”
UW Medicine operates the biggest heart-transplant program in the Pacific Northwest. It is led by Drs. Jay Pal, surgical director, Daniel Fishbein, medical director of heart transplant services, and Lisa Guertin, associate director of heart transplant.
On Sept. 9, nearly a month after Stovall’s procedure, the United States recorded its one millionth organ transplant. Innovations such as DCD transplantation should enable the next such milestone to be reached faster.
Dominic Adorno, vice president of clinical operations at LifeCenter Northwest, noted that, as of August 2022, only 496 U.S. heart transplants have involved a DCD organ – and of those, 489 have happened since 2020.
“We are one step closer to realizing LifeCenter’s vision, which is a future where no one dies on the organ transplant waiting list. It is something we can’t do alone,” he said. “None of these advancements in technology have meaning without the donor and the donor family. I’m grateful and continually inspired by their generosity.”