Saving children’s lives with world-first ‘dead’ heart transplants

https://www.thetimes.co.uk/article/nhs-saves-childrens-lives-with-world-first-dead-heart-transplants-b0httn8lb

by blacktulip • 5 years ago

72 62 5 years ago

thetimes.co.uk

blacktulip2• 5 years ago

twitter thread without a paywall: https://twitter.com/thesundaytimes/status/136340724792211046...

sefrost• 5 years ago

With The Times website, if you add an extra "/" at the end of the URL, it will bypass the paywall.

i.e. https://www.thetimes.co.uk/article/nhs-saves-childrens-lives...

hkt• 5 years ago

Hilarious and brilliant tip, thank you!

InfiniteRand• 5 years ago

The UK study seems to be the pioneer but it is worth noting that this procedure is also being tested out in the US now https://www.statnews.com/2020/01/16/heart-transplant-donatio...

It’s a good sign that the procedure is spreading

emteycz2• 5 years ago

From their page it seems like it's from the US...?

https://www.transmedics.com/ocs-hcp-heart/

https://www.transmedics.com/our-company/

CapriciousCptl2• 5 years ago

The device used is extraordinary. The US has been using it for a year and a half in adult trials. Transmedics also has devices for the lungs and liver. Livers and to a lesser extent lungs already get transplanted after cardiac death when they’re judged to be viable— the key being that this device could quality of those organs and therefore more could be transplanted! This could benefit a lot of people— not just hearts!

https://www.transmedics.com/ocs-hcp-heart/

iso12104• 5 years ago

This is the UK, so the parents would have ended up with a hospital bill of £0 and an ambulance bill of £0.

intricatedetail• 5 years ago

Bill is included in the income tax. Funnily enough it does not apply to people living off shares, they truly pay £0 or close.

geden• 5 years ago

Dividends are mildly taxed now.

blacktulip2• 5 years ago

Do you mean stock dividends? They are taxed - and not lightly: https://www.gov.uk/tax-on-dividends

uncledave3• 5 years ago

This. I wish people would stop saying the NHS is free because it's not.

It's equal for everyone regardless of your income and that's awesome as far as I'm concerned. Some others, not so much, particularly those who think that they shouldn't pay for someone else's treatment.

mhh__• 5 years ago

The NHS is generally pretty good at this kind of operation, the rot is really around things like mental health which don't fit a beveridge model very well

cmehdy• 5 years ago

I didn't know about the name of the model, so I went on a quick search of the models and found this[0] short explanation for any other curious reader.

[0] https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/...

moritonal• 5 years ago

TIL the Beveridge Model is a health care system in which the government provides health care for all its citizens through income tax payments.

emteycz2• 5 years ago

But sometimes NHS won't pay and will forbid you from paying yourself: https://edition.cnn.com/2018/04/25/health/alfie-evans-appeal...

CraigJPerry• 5 years ago

NHS has nothing to do with electing to pay for your own treatment - people do it sometimes for elective stuff.

That was a court of law which ruled in that case (and then again for multiple appeals processes), the NHS has no such power.

ealexhudson• 5 years ago

NHS won't forbid you from paying, such an order would come from the Courts. It's an exceptional case that a family would have this kind of rule imposed on them, but Courts will consider the patient's best interests before the family's.

nkoren• 5 years ago

That was not a dispute about payment.

throwaway316943• 5 years ago

That’s an obscene example of government interference with family and human life. This is an extreme example but there are many more misery inducing circumstances that are by products of a single payer system wedded to government. One of the most pervasive is a general rationing of care with long delays before procedures or even basic diagnostic tests but there are others like having to be assigned a doctor or having little to no choice of hospitals or clinics. The modern world needs a system that provides options for everyone and there must be a way to structure healthcare so that those who can’t afford it still receive it while those who can are able to buy the service they want. Everyone should receive the best care but you have to allow the market to find the best solutions do everyone can benefit from them. It’s just like taxing the rich if you want to look at it that way, they shell out gobs of money to create a demand for top notch doctors and facilities and the government then legislates that those resources must also provide care for everyone in exchange for access to something only the government can provide like tax breaks etc.

matthewmacleod2• 5 years ago

Please do not spread misinformation – this was not a case about the health service paying for treatments. It was specifically about whether or not life support should continue to be provided, or whether doing so was inhumane.

godelzilla• 5 years ago

... and unnecessary middlemen playing casino with human lives (aka health insurers) don't extract a huge payday.

spyridonas• 5 years ago

How do they know that the dead heart will not die again? Do they repair it before transplant ? Also shouldn't the heart be from an equally aged human?

CapriciousCptl2• 5 years ago

Broadly speaking, two types of death are recognized with organ donation. Brain death, where there's no brain function at all and cardiac death, where there's no cardiopulmonary function.

Brain death in isolation generally provides the most viable organs, since it minimizes so-called "warm ischemia" time, which is the time that the organs are warm and without viable blood flow. However, sometimes patients don't meet brain death criteria strictly, or they do but the donor next of kin decides to donate after cardiac death (actually, the next of kin/family determines what the donor would have wanted and there is a strict legal/ethical precedence on what opinions count). In those cases, cardiac death is initiated by stopping life support and waiting 2-10 minutes after "death" to initiate organ harvest.

So, it's not that the heart caused death, it's just that it stopped beating, generally, due to lack of oxygen. Which means some of its cells certainly died, but by minimizing the warm ischemia time (by hooking up to a kind of life-support machine), that damage can be limited.

Patients do not have to matched strictly by age. Anatomically-speaking, body-size is the most important criterion. Obviously, matching needs to happen on antibodies/rejection and several other factors as well.

jl6• 5 years ago

There is always a risk that the grafted organ may fail or be rejected or even bring new problems with it (e.g. smokers can donate lungs). But the recipients are typically gravely ill, and an imperfect donor organ may provide longer or higher quality life than doing nothing.

Sone transplantees go on to live full lives for many decades. Others might need a retransplant.

But while complications may occur, the fact transplantation works at all is a minor miracle that we should celebrate.

Some patients die on the waiting list. If you haven’t already, please register to donate your organs. It costs you nothing.

aksss2• 5 years ago

Fascinating about the smoker lungs. I wonder if a non-smoker with aged smoker lungs ever tastes “smoke”/tobacco in the subsequent weeks/months. So many questions.

macksd• 5 years ago

In what sense were previous heart transplants not dead? Would they only use hearts that were kept pumping right up until they were surgically removed from the donor? I thought they were previously transported on ice, and assumed their must be some period of time during which the hard was considered dead - wondering what's so fundamentally different beyond the device that circulates donor blood through the heart.

carbocation• 5 years ago

I think this is an important question. Donation of organs after death can happen when people are declared dead due to brain death, or when they are declared dead due to classical criteria including cardiac death.

"Donation after cardiac death", as you might imagine, seems a bit weird when the heart is the organ being donated. And so it's a recent invention for the heart (though it has been around for a long time for other organs such as the kidney[1]). There is a free access article from 2018 about the necessity and ethical considerations of cardiac donation after cardiac death in Circ: Heart Failure [2].

1 = https://health.ucdavis.edu/transplant/nonlivingdonors/donati...

2 = https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.118...

pontifier• 5 years ago

It seems like most other hearts were removed live after brain stem death. My take is that in this process, hearts that had stopped beating in a donor due to death from other causes were revived after removal.

frosted-flakes• 5 years ago

Would they only use hearts that were kept pumping right up until they were surgically removed from the donor?

Correct. I went through this with a family member who was struck by a car and later declared brain-dead in hospital—but his heart was still beating, and thus a candidate for heart donation. We said our final goodbyes before he was wheeled away for surgery, heart still beating and looking as alive as ever. The anonymous recipient underwent surgery simultaneously in the same hospital, so presumably the heart only stopped beating for a very short period of time before it was re-started, and it continues on beating to this day (it's a funny feeling, knowing that).

dm3193• 5 years ago

Another relevant point is that England has changed its organ donation policy to opt-out [1], with Scotland to follow next month. Wales is 'deemed consent', which doesn't sound too different to opt-out. Northern Ireland is opt-in.

[1] https://www.organdonation.nhs.uk/uk-laws/

teruakohatu• 5 years ago

Unfortunately here in New Zealand we have essentially neither opt in or opt out. It is technically opt in, but if you opt in they wil only take them with family consent. So in effect it requires a pre and post death opt in.

This puts grieving parents or other loved ones in a horrible position of having to make a decision concerning the person they just lost. It also means I don't have the final determination on my own organs.

There is talk about making it opt out... But that would make it even less useful when next of kin get the final say.

williamdclt• 5 years ago

Good reminder to talk about it (and other death-related things like funeral) with your family. They're more likely to respect your wish if you told them explicitely, than if a doctor they don't know tells them "they opted in, do you consent"

loloquwowndueo• 5 years ago

Click the link, content loads, then is immediately obscured by a “we need your consent” pop up. But content had already been loaded so why can’t I just read the thing?

I have better things to do with my time. (Like whining here hahah).

crazypython• 5 years ago

I just use Bypass Paywalls[0] and Web Annoyances Ultralist (blocks cookie banners, autoplaying videos, sticky navs). https://jameslu.substack.com/p/hide-cookie-banners-paywalls-...

[0] https://github.com/iamadamdev/bypass-paywalls-chrome/blob/ma... [1]: https://github.com/yourduskquibbles/webannoyances

neonate• 5 years ago

https://archive.is/AzPtF

Saving children’s lives with world-first ‘dead’ heart transplants

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