2023-12-04 17:55:13
‘A heart for three’: this is how we could summarize the news featuring American surgeons who have successfully performed a heart re-transplant, i.e. the grafting of a heart already transplanted into a patient, who subsequently died, to a second sick. The organ therefore ‘beat’ in the bodies of three people: that of the initial donor, that of the first recipient and that of the second. This type of operation – performed only 7 times in history – involves an ethical question as the second recipient benefits from a ‘recycled heart’ (an expression used in some medical publications), therefore it requires, before proceeding, an in-depth comparison and a convinced consent on the part of the patient who will be the ‘second-hand owner’ of the organ.
The story begins when a 21-year-old boy is diagnosed with severe heart failure. The heart of a 30-year-old who died after an overdose based on methamphetamine and synthetic cannabinoids is transplanted. Before each transplant – reports the website of the French newspaper ‘Le Monde’ – there is a cessation of blood circulation in the organ. This period of time is called ‘cold ischemia time’ because the graft is placed under hypothermia in an isothermal container to reduce the consequences of not perfusing the organ with oxygenated blood. The tolerable cold ischemia time for a heart graft is less than 4 hours (i.e. 240 minutes). As for the 21-year-old patient, whose case was reported by surgeons at George Washington University and described in the ‘Texas Heart Institute Journal’, the ischemia time was 188 minutes.
The day after the heart transplant, the young man unfortunately had a very serious stroke. However, he continued to receive anti-rejection therapy, but his neurological conditions worsened until, 6 days after the transplant, he was declared brain dead. However, the transplanted heart continued to function and the left ventricle contracted normally. The surgeons then considered transplanting the heart to another patient, in this case a 63-year-old man with a family history of heart disease, who had already had a myocardial infarction, was wearing an implantable defibrillator and was suffering from chronic kidney failure. The patient had been on the heart transplant waiting list for 366 days.
The surgeons then proceeded and this time the ischemia time was 100 minutes. There were no postoperative complications and the man returned home 17 days after surgery. Cardiac ultrasound showed that the left and right ventricles were functioning normally, there was no sign of rejection and he is doing well 7 months after the transplant.
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