A small 60 gram heart saved the life of a child hospitalized for months at Bambino Gesù. It is the first transplant in Italy in which – at a pediatric level – an innovative temperature-controlled heart transport system has been used. The system guarantees a constant temperature of the organ of 5 degrees and, through a dedicated app, allows the doctors involved in the transplant to follow the geolocation of the transport and remotely monitor the temperature of the heart. The child who received the organ had restrictive cardiomyopathy and had to be supported with a mechanical assist device (artificial heart) before the transplant. His current conditions are good and he has already been discharged from the hospital.
A Race Against Time
Speed and accuracy are the hallmarks of organ transport procedures. The medical team of the receiving hospital, having acquired from the National Transplant Center the availability of an organ to be harvested, immediately leaves for the donor hospital to perform the harvest. Everything happens very quickly. The harvested organ is placed in sterile bags containing a cold solution and placed in a refrigerated container filled with ice. This method, called “cold ischemia” (ischemia is the interval during which the organ remains outside the body) allows the human heart to be protected from ischemic damage between collection and transplantation for a period of three or four hours.
The Temperature Controlled System
The scarcity of available organs and the need to transport them from long distances has prompted research to invest in systems that can best guarantee the conservation of the organ to be transplanted, minimizing the risk of deterioration. In the field of pediatric heart transplantation, where the availability of organs is extremely limited, the “SherpaPak CTS” temperature-controlled cardiac transport model has been perfected. The system, developed a few years ago by a US company and approved by the FDA in the United States and with the CE mark in the European Union, consists of several components. The outermost part consists of a transport carrier that contains various temperature controlled packaging elements.
At the heart of the system is a rigid shell in which the heart is submerged and suspended in a cold storage solution for the transport of donor hearts. The presence of dry ice on the outside of the container ensures a contrast temperature around 5 degrees centigrade, avoiding excessive cooling of the heart which could lead to cellular damage. A data logger monitors and displays the temperature of the solution in which the heart is immersed during transport between operating rooms and allows the medical team involved in the transplant to monitor it along the way. There are also similar devices for transporting other organs: lung and liver.
“The most important advantage – says Antonio Amodeo, head of heart failure, transplantation and mechanical cardio-respiratory assistance at Bambino Gesù – is that within this system temperatures never drop below 2 degrees, as can happen in traditional transport. The system prevents the risk of freezing of parts of the surface of the heart by keeping the temperature of the entire organ constant. In fact, it has been ascertained that temperatures below 2 degrees cause damage to the cellular structure of the heart”.
The system is already in use in some European hospitals while in Italy it has been used on occasion only for the transport of organs for adults. That of Bambino Gesù was the first temperature-controlled transport in Italy of a heart intended for transplantation for a child.
“The Bambino Gesù Hospital – concludes Amodeo – has chosen to invest in the most advanced technologies, as well as in scientific research, because the responsibility of providing answers to families with a sick child who experience the drama of waiting lists for the heart transplant. Our responsibility equally extends to the families of donors whose great generosity is a precious gift never to be put at risk”.