For the first time, a heart transplant has been successfully performed after transport of a donor heart across the Atlantic Ocean, marking a substantial advancement in the realm of organ transplantation.
The heart transplant took place at the Pitié-Salpêtrière Hospital, Sorbonne University, in Paris, France, in January, 2024.
The donor, located in the French West Indies, was a man aged 48 years, declared brain dead 3 days after an intracerebral haemorrhage.
Echocardiography and coronary angiography were unremarkable.
The heart was transported to Paris in the cabin on a commercial airline flight. Preservation (12 h 6 min) and perfusion (10 h 32 min) was uneventful, despite severe turbulence.
The recipient, a man aged 70 years, with terminal ischaemic cardiomyopathy and chronic renal insufficiency (estimated glomerular filtration rate [eGFR] 24 mL/min per 1·73 m2) was consented and registered on the PEGASE trial waiting list (NCT06035991).
After transplantation, the heart immediately had normal biventricular function without any graft dysfunction.
This transplant marks the first instance of a donated heart being flown across the Atlantic, covering a distance of 6750 km from the French West Indies to Paris, a feat previously unimaginable in organ transplantation.
The success achieved in this instance, in which distance and transport time are no longer limiting factors, has the potential to redefine the landscape of heart transplantation with unlimited geographical procurement and lowered time constraints.
In recent years, the concept of using a machine to continuously pump an oxygenated fluid through the heart during transport has been under evaluation in clinical trials. No studies have, however, explored extreme (>10 h) transport times.
This case is the inaugural event in an investigator-initiated clinical study, approved by ethics committees and regulatory authorities, investigating the feasibility of preserving donor hearts using hypothermic oxygenated perfusion for extended transport times. The aim of the project is not to achieve a feat, but to set up a sustainable cardiac donor programme in the French West Indies.
Beyond the proof of concept of prolonged heart-graft preservation, the initiative wanted to make this operation reproduceable and keep transport costs bearable.
The successful outcome of this report may be a monumental breakthrough in heart transplantation allowing for increased access to unused donor hearts, that can now be used and safely transported across vast distances.
Additionally, it suggests a reorganisation of transplant procedures, allowing for better scheduling and expert-led surgeries. These changes might improve overall outcomes and redefine the approach to cardiac transplant care.
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