One of the greatest short stories ever written is Edgar Allan Poe’s “The Tell-Tale Heart.” In this 1843 classic, the murderer of an old man is tortured by the sound of his victim's heart continuing to beat, a sound which no one else seems to hear. The relentless beating eventually leads the murderer to confess. That creepy tale certainly kept a 10-year-old Arthur Caplan awake at night.
Now there's a machine that can do what Poe imagined — preserve a beating heart in isolation. And while this might seem to be the yuckiest idea to come down the pike in a long time, it really represents a bold and fascinating advance in trying to save the lives of people with failing hearts.
The “heart in a box” machine, known as the Organ Care System, is made by TransMedics Inc., of Andover, Mass. Doctors in Pittsburgh recently announced that they used the machine to keep hearts beating for hours on their own after being removed from cadavers. Three patients, a 47-year-old man and two women in their 50s, received these hearts and all seem to be doing very well.
The machine will be tested further in the coming year at five transplant centers in the U.S. — the University of Pittsburgh Medical Center, Brigham and Women's Hospital in Boston, UCLA Medical Center in Los Angeles, the University of Chicago Hospitals' Cardiac Center and the Cleveland Clinic. The researchers want to be sure that hearts transplanted out of the box really work as well as those preserved by current methods.
Until now, when a heart was donated upon someone’s death, the organ was saturated with preservative fluid and stashed in a thermos-type cooler packed with ice. We’ve all seen the images of people in white coats running to or from airplanes, cooler in hand, racing against the clock to get an organ to someone in desperate need.
Hearts are very fragile and can sometimes be damaged by the current standard method of preserving them on ice.
Inside the new transportable box, a machine pumps donor blood through the heart without requiring cold temperatures or artificial preservative fluids. The company says a heart kept functioning this way can be preserved for at least 24 hours.
If this machine succeeds in keeping hearts beating safely in more trials, then instead of the current six-hour limit that existing preservation techniques allow, hearts could be moved anywhere in the country to where someone needs one without worrying about how long the process is taking. And some hearts that might not be strong enough to last using current techniques might be able to be salvaged and transplanted using this new technology.
There is no denying that, as Poe understood, the image of the beating heart outside the body is macabre. That is until you imagine a family grieving over the loss of a loved one because there was no heart to transplant. That truly nightmarish image is the one this new machine may help prevent.
Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.
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