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2 December 2017

Pioneering treatment endorsed by study as world marks first heart transplant anniversary

Exactly 50 years after the world’s first successful human heart transplant was performed, results from a new study back a pioneering technique which allows surgeons to use donor hearts that have stopped beating – and massively increase the number of lives saved.

Surgeons at Cambridge’s Papworth Hospital performed Europe’s first transplant using a heart from a circulatory determined dead donor (DCD) in March 2015, and have so far successfully treated 37 patients with the procedure, increasing the total number of heart transplants carried out at the hospital by a third.

The hospital has performed more than 1,400 heart transplants in total, but previously surgeons were only able to transplant beating hearts from donors following the diagnosis of brain death (DBD).

Now a newly published paper - Outcomes following heart transplantation from donation after circulatory determined death (DCD) donors – reveals the survival rate and recovery of 28 DCD recipients were comparable to those of matched DBD recipients over a 25-month period.

Speaking ahead of the 50th anniversary of the world’s first successful heart transplant – in Cape Town, South Africa on 3 December, 1967 – Professor John Wallwork, Chairman of Papworth Hospital Foundation Trust, said the success of Papworth’s DCD programme had significantly helped to address the shortage of donor hearts in the UK.

“Donor numbers are falling – mainly because of improvements in road safety and better management of health conditions like high blood pressure. There used to be around 400 heart transplants carried out every year in the UK, last year there were 178. The DCD procedure has managed to take hearts from donors we wouldn’t normally have used and offer many more people a second chance at life.”

Consultant Cardiothoracic Surgeon Mr Stephen Large, who led the Papworth team during the hospital’s first DCD heart transplant, added: “It’s great news; the results show the DCD procedure is at least as good as conventional DBD heart transplantation. We know that 56 per cent of people on the waiting list don’t get transplanted because there are not enough donors, it’s a stark illustration of just how vital these extra donor organs are.”

Mark Serwotka, leader of the Public and Commercial Services Union, who received a DCD heart at Papworth in 2016, said the operation had transformed his life. “When you finally get the nod that the transplant is on it comes as such a relief – I’d lost about 3 stone by that point, and I had the feeling that we really needed to get on with it. I would say to anyone who’s not a donor to try and understand what it can give people. Out of tragedy – admittedly - is a chance for life.”

The programme – which also offers unique research opportunities that could benefit millions of people who suffer coronary occlusions and heart attacks - represents the latest in a long line of historic breakthroughs at the hospital, which includes the UK’s first successful heart transplant, performed by Sir Terence English in 1979.

Professor Wallwork, who performed Europe’s first successful heart-lung transplant at Papworth in 1984, said heart transplantation was now almost a routine part of healthcare, with 80 per cent of patients expected to live for at least five years.

“When the first heart transplants were done the patients became celebrities. The nice thing now is that people can have the operation and then go back to living their normal lives. In a way, the operation itself has become procedural; the focus is keeping people alive for many years, and that’s the way we run the transplant service at Papworth.”

'Our biggest problem'

Transplantation at Papworth has also evolved in terms of organ procurement. Up until the early 1980s the donor was co-located with the transplant patient in the hospital during surgery.

“Now you wouldn’t imagine moving the donor,” said Mr Pedro Catarino, Clinical Director of Transplantation and Consultant Cardiothoracic and Transplant Surgeon at Papworth Hospital.  “We have better organ preservation, better ways of looking after the heart. It means we can reach a donor heart in most places in the UK and get it back and transplanted within the four hours we have to do it.”

“Our biggest problem is the availability of donors, and then obtaining family consent. Around 43 per cent of families say no – even when the would-be donor is on the donor register.”

NHSBT’s recent Annual Report on Cardiothoracic Transplantation revealed that Papworth – which performs more adult heart transplants each year than any other hospital in the UK - is leading the way in heart and lung transplant survival rates.

The Trust had the best results in the UK last year, with more than 97 per cent of patients receiving a heart transplant surviving for at least 30 days, compared to a UK average of 89.9 per cent.

Thirty-day survival rates for patients receiving a lung transplant were at 94 per cent compared to the UK average of 90 per cent.  Last year Papworth also had the lowest decline rate for donor organs, meaning it accepts more organs offered for donation than any other UK centre.

To join the NHS Organ Donor Register, please telephone 0300 123 23 23, or go to www.organdonation.nhs.uk / www.organdonationscotland.org to register online.