Advance with MUSC Health

Cutting-Edge Technology Improves Wait Times and Outcomes for Heart Transplant Patients

Kat Hendrix, Ph.D.
October 21, 2021
Doctor Hashmi

The Heart Transplant Program at the Medical University of South Carolina (MUSC) is leveraging the latest technology to serve patients waiting for a donor organ in South Carolina. A novel device called the SherpaPak® Cardiac Transport System now allows the MUSC team to travel further than ever before to procure hearts for their patients. “It will increase transplant volumes in our community by doubling our traveling distance from 500 to 1000 miles away and eventually more,” says  Z. Hashmi, M.D., a cardiothoracic surgeon and expert in organ procurement and thoracic transplantation at MUSC.

“Prior to this, our reach was limited to states immediately surrounding us. Now we can go to Chicago, Texas, and New York. Our patients can get transplanted faster because we have a bigger pool of donors,” says Hashmi.

This is a significant advantage because transplant patients must match their donors on multiple criteria. Parameters such as blood type, height and weight all factor into the equation when identifying a donor organ for a particular patient. “Some people wait weeks and others wait easily over a year or more because they can’t find a match within our traveling distance,” said Hashmi. “Having this device gives them more chances to match all of those characteristics.”

The custom-designed SherpaPak unit provides for the static hypothermic preservation of hearts during transportation. It stabilizes and insulates the organ to protect donor hearts better from thermal and physical damage during transport. Its leak-proof, temperature-controlled canister is a significant step forward compared with the previous method of transporting them in fluid, on ice, covered in plastic bags. “Before, we literally brought the organ back in an ice cooler,” said Hashmi.

When the donor organ got too cold or made close contact with the ice, it is believed that cellular-level damage occurred, possibly injuring tissue and sometimes affecting outcomes. “Like anything you freeze and thaw, there is a possibility of cold damage at the microscopic, cellular level,” said Hashmi. But there was no way to monitor temperatures inside the coolers, and ice was the only option for preserving the organ during travel. “It was like putting drinks in a cooler and going to the beach. You just hoped it stayed cold enough,” Hashmi explained. “With this new device, we can monitor the temperature of the organ on our phone apps and keep it at the ideal level – about 2 to 8 degrees Celsius – so it stays cool without freezing. Plus, it stays cold longer, so we can go further away.”

Because the heart is better protected during transport, it has better overall quality and recovers faster when it is transplanted into a recipient, even after a journey of six hours or more. “Recently, we went out to Nashville, Tennessee,” Hashmi said, “to bring back a heart that matched one of our patients. Prior to this, we would have hesitated to go that far. But we had confidence in the device, and it worked great. The heart felt nice and supple when we retrieved it from the device. It was uniformly cold with no frozen ice spots or ice injury. The patient has done really well post-transplant.”

These results are consistent with reports from other centers using the SherpaPak and Hashmi’s own experience. “We’ve just started using it here at MUSC, but I used it for the last couple of years at Baylor University Medical Center before I came here,” said Hashmi. “From what I saw there and reported data, these hearts do recover a lot quicker, and there’s less post-operative primary graft dysfunction, which is what we’re always worried about.”

Hashmi was drawn to MUSC by the opportunity to expand the possibilities in transplantation. “I wanted to help to establish new frontiers in transplantation and grow the program here,” he said. While MUSC has long had a Donation After Brain Death (DBD) program for procuring transplantable thoracic organs from patients declared brain dead by neurologic testing or lack of blood flow, Hashmi is helping to start a thoracic Donation After Cardiac Death (DCD) program. The DCD program involves patient donors whose prognosis is very poor after a traumatic event and whose families have made the decision to withdraw care. Because the process of organ procurement in DBD and DCD programs is quite different, many centers only have a DBD program.

“We want to be able to do both because you never know when a match will happen, and some people are waiting a long time for transplantation,” said Hashmi. “We want to give them the best opportunity and the most options we can to get them quickly and safely transplanted.”

Technological advances that push the boundaries of what’s possible are what keep him excited about this field. “Transplantation has always fascinated me. How we can take something that was created in one person and put it into someone else who can then function with that organ. I just want to be part of that kind of medicine,” he said.

But it’s the patients who really inspire and motivate him. “I recall one young patient in her mid-30s who played in a symphony orchestra, but she’d had to stop due to her condition. After her transplant, I went to hear her play at a Christmas symphony performance and, at the end, she thanked her medical team. It felt so good that we were able to do this for her, and then, there she was creating wonderful memories for everyone there.”

The MUSC Health Advanced Heart Failure Program has grown tremendously in the past few years. During the last calendar year, MUSC performed 54 heart transplants in adults, placing it in the top tier in volume of adult heart transplants in the United States. In addition to being a high-volume center, the MUSC Health Heart Transplant Program was designated a Blue Distinction Center+ for outstanding outcomes and quality of care in heart transplant. The program performs other cutting-edge heart failure procedures, including minimally invasive left ventricular assist devices and has established a regional cardiogenic shock program.

“MUSC is a premier advanced heart failure center, and we are constantly looking to participate in trials and pioneer innovative care in the field of heart transplantation and mechanical circulatory support. Having cardiothoracic surgeons who are very experienced in organ procurement such as Dr. Hashmi allows us to push the boundaries even further, including the use of DCD donors and the SherpaPak system”, says Arman Kilic, M.D., who serves as the Surgical Director of the Heart Failure and Heart Transplant Program at MUSC.

About the Author

Kat Hendrix, Ph.D.

Keywords: Heart Care, Transplant