‘Heart in a Box’ Device Resuscitates Hearts Removed from Dead Bodies

UK doctors may have discovered a real-life Reanimator device, as the new “heart in a box” machine has successfully revived hearts from donors who have passed away, which could allow for up to 30% more viable heart transplants.

Transplant surgeons generally recognize two types of death: brain death and circulatory death, the latter of which occurs when the heart stops beating and pumping blood throughout the body. Usually, surgeons only transplant hearts from brain dead donors whose bodies are still healthy, but this new device could allow for transplants following circulatory death, which would widen the donor pool considerably.

The device consists of a cart on wheels that contains an oxygen supply, a sterile chamber, and tubing that hooks up to the deceased heart and provides it with blood and nutrients. It needs to be attached within twenty minutes of circulatory death, as the lack of oxygen running through the body begins to damage organs almost immediately. In one recorded case, the heart was removed and placed in the chamber within two minutes of the patient’s time of death.

“The device is vital. The heart gets an absolutely essential infusion of blood to restore its energy,” said Stephen Large, a surgeon at Papworth Hospital.

The machine was developed by US-based company Transmedics, and has been used in at least 15 cases to transplant formerly dead hearts in the UK and Australia. It is unknown exactly how many have been successful, but of the eight that have occurred at Papworth Hospital, the machine has been confirmed to work as advertised in seven cases. It is pending approval in the US, and doctors estimate that with widespread use, it could increase the number of viable donor hearts by 15-30%.

The device could undeniably save many lives, but it’s still extremely controversial. Many ethical problems arise when a heart from a dead donor is literally restarted inside another person: if the heart can be restarted in someone else’s circulatory system, then why wouldn’t we use the technology to restart the heart in the donor? Robert Truog, a medical ethicist at Harvard University, argues that the usage of the machine needs to be determined on a case-by-case basis, with the emphasis placed on consent:

“My argument is that they are not dead, but also that it doesn’t matter,” Truog told Technology Review. “They are dying and it’s permissible to use their organs [so long as they and family members have given consent]. The question is whether they are being harmed, and I would say they are not.”

It’s a difficult issue with no easy answer, but focusing on consent seems relatively safe. If a person is dying of an incurable disease, for example, then even if the person isn’t technically “dead,” giving permission for this procedure is similar to a DNR. The device will need to be used with discretion, but considering that there are not nearly enough brain dead donors for the hundreds of thousands of people at any one time who are experiencing heart failure, the results can’t be ignored.