Toronto hospital performs first Canadian heart transplant after circulatory death

In a groundbreaking first for Canada, surgeons at Toronto’s University Health Network (UHN) have successfully completed a heart transplant using a donor whose heart had stopped beating, a technique known as donation after circulatory death.

Unlike traditional heart transplants that use organs from brain-dead donors whose hearts continue to beat, this new approach recovers hearts after life support is withdrawn, and the heart has stopped beating.

In early September, a team at UHN’s Toronto General Hospital transplanted a heart that had stopped beating after life support was withdrawn.

Dr. Ali Rabi, the cardiac surgeon at UHN’s Peter Munk Cardiac Centre who led the surgery, said, “Before, we only used hearts from brain-dead donors whose hearts were still beating. Now, we can use hearts that have stopped beating after life support is withdrawn.”

This new method allows doctors to do the same surgery on more viable donors and increase the number of hearts available for use.

“These are donors who are not considered brain dead. They have a few basic reflexes but no prospect of recovery. That decision is made by the patient, their family, their treatment team, and a neurology team. The family then decides they do not want their loved one to continue like this.”

This innovative step in the world of organ transplants marks a turn for those waiting for a new heart.

Heart failure is one of the most common reasons people are admitted to hospital in Canada and is a leading cause of death.

The Canadian Institute for Health Information says by the end of 2024, there were 155 adults and 29 children waiting for a heart transplant.

“Because of this surgery, we increase the number of heart transplants by 20 to 40 per cent. This will also reduce the number of people who never receive a heart transplant and die waiting for one,” Rabi said.

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The technique has been used successfully in other countries, including Australia, the U.K., and the United States. In Canada, this method is expected to increase heart transplants by about 30 per cent.

“When the heart started beating again in the new patient, it’s amazing. The heart’s natural strength is incredible.”

Ontario’s Deputy Premier and Minister of Health, Sylvia Jones, praised the achievement in a release posted by UHN. “This breakthrough shows how innovation can save more lives. Congratulations to UHN for this historic milestone,” she said.

Rabi also acknowledged the generosity of donor families, noting, “It’s the hardest day of their lives, but many find comfort knowing their loved one helped save others.”

Recent data from Australia and the U.S. show no difference in long-term survival between recipients of DCC (donor after circulatory death) hearts and those from traditional brain-dead donors, according to Dr. Rabi.

“I encourage young people who are interested in heart failure and heart transplant to look at the field, and I guarantee you in the next five years, the field will be completely unrecognizable,” he added.

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