Novel method of perfusion gives longer life to donor hearts

Prof Frank Rosenfeldt & Ms Chris Egan

An Alfred-Monash group of surgery researchers have previously showed that donation after circulatory death (DCD) canine hearts can be resuscitated if perfused with warm blood. However, clinical application of this technique is complex and difficult. The group has developed a simplified system of cold crystalloid perfusion and compared it with standard cold storage for DCD heart preservation.

They found that continuous cold crystalloid perfusion in a canine model of DCD facilitates aerobic metabolism and resuscitates the DCD heart, and provides functional and metabolic recovery superior to cold storage. Prof Frank Rosenfeldt said, "We believe that this shows promise for improved clinical preservation of DCD and marginal donor hearts."

Reference: Choong JW, Ou R, Lim YW, Rosenfeldt FL. Cold crystalloid perfusion provides cardiac preservation superior to cold storage for donation after circulatory death. Transplantation. 2015 Nov 13. [Epub ahead of print]

Odd spot: Heart donation & when is dead not dead?

The Medical Journal of Australia recently published an article entitled "Transplantation of the heart after circulatory death of the donor: time for a change in law?" Prof Frank Rosenfeldt, Department of Surgery, (pictured with a patient) said that the article will increase both medical practitioners and the general public's confusion about the legal point of death and possibly affect donor rates, already low in this country. The Age has subsequently published a critique, which can be read in full here:
Surgeons hit back at claims heart transplants are against the law.

See also: Push for Australia to introduce opt-out system for organ donation

Twelve-hour reanimation of a human heart following donation after circulatory death

Prof Frank Rosenfeldt
with the prototype rig

Despite increasing use of donation after cardiac death (DCD) and encouraging results for non-cardiac transplants, DCD cardiac transplantation has not been widely adopted for two reasons. The DCD heart sustains warm ischaemic injury during the death process and conventional static cold storage significantly adds to the ischaemic injury. Alfred-Monash researchers have developed a simple system for perfusion of the DCD heart with cold crystalloid solution using gravity-feed that can reduce ischaemic injury and potentially render the heart suitable for transplantation.

Professor Frank Rosenfeldt wins Surgical Research Award

Prof Frank Rosenfeldt was awarded the 2012 Surgical Research Award in May 2013 at the 82nd Annual Scientific Congress of the Royal Australasian College of Surgeons (RACS). This is an honour created by RACS to recognise the contribution of a pre-eminent surgical scientist who has made significant contributions to surgical research. One of Prof Rosenfeldt's major research interests is to increase the viability of donor hearts for heart transplants.