Heart surgeons and operating room nurse during surgery. (Representative image) Getty Images
For the first time, donor hearts that once lay still after death are being revived without controversy or cost, thanks to a breakthrough by Vanderbilt scientists.
Heart transplants from donors after circulatory death (DCD) have long been rare, largely due to technical, ethical, and financial roadblocks.
Traditional methods to preserve these hearts either involve reanimating them inside the donor’s body, a process banned in several regions due to ethical concerns, or rely on expensive, machine-based perfusion systems that mimic the heart’s function outside the body.
Now, researchers at Vanderbilt University Medical Center have developed a third option: rapid recovery with extended ultra-oxygenated preservation, or REUP.
Instead of reanimating the heart, REUP uses a cold, oxygen-rich preservation solution to flush the organ shortly after death.
The process is simpler, more affordable, and sidesteps the ethical challenges that have stalled DCD transplants in many parts of the world.
“It’s something that has never been done in the field of heart transplantation with success,” said Dr. Aaron Williams, the study’s lead author.
“I think this is really going to be a game changer. This is going to be a technique that’s going to essentially have worldwide applicability.”
Since November 2024, Vanderbilt has used REUP in 20 successful heart transplants, with outcomes on par with current standards.
Beyond improving transplant success, the technique could vastly expand access to DCD donor hearts globally, unlocking hundreds more viable organs each year.
“This arose out of the problems with the other two methods—the ethical issues with one and the cost with the other,” Williams said.
“We’ve all been thinking about these issues for some time. As a team, we came up with this cardiac preservation solution that helps resuscitate and protect DCD hearts so they can be used for transplantation.”
The REUP method involves oxygenating a chilled preservation solution, which comprises of packed red blood cells, del Nido cardioplegia, and other additives, and flushing it through the donor heart shortly after death.
This halts cellular decay, reduces inflammation, and preserves heart tissue during transport without reanimating the organ.
By removing the need for costly perfusion machines and avoiding the ethical gray zones of in-body reanimation, REUP addresses two of the most significant barriers to DCD heart adoption. That could be transformative, especially in regions with fewer resources or stricter transplant protocols.
The Vanderbilt team has shown that hearts preserved with REUP remain viable for up to eight hours, offering surgeons a wider window to recover, transport, and transplant donor organs. In the past, tight timeframes and fragile heart conditions made many DCD organs too risky to use.
Before 2020, Vanderbilt’s transplant program only accepted organs from brain-dead donors. But in recent years, it has emerged as a leader in DCD heart transplantation, driven by innovations in preservation. REUP is the latest and most promising leap in that evolution.
Looking ahead, researchers believe REUP could be adapted for other organs, including livers, kidneys, lungs, and even pediatric transplants.
The findings have been published in the New England Journal of Medicine.
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