Successful Transplant of a Robotic Heart

India has a dismal 0.65 per million population (PMP) Organ Donation Rate.

There is a need of about 1.5 to 2 lakh kidney transplants a year, while only about 8,000 transplants happen. Also, as against 40,000-50,000 liver transplants required a year, about 1,700-1,800 happen each year. Estimates also say that about 15,000 heart transplants are required a year but only about 250 heart transplants happen every year. Roughly 5 lakh people die annually in India due to lack of an organ donor but with less than one per million people opting to donate, the organ donation rate in the country is one of the lowest in the world, according to estimates.

And countless more people in need of “spare parts” never even make it onto the waiting list. As a result, hundreds of thousands of Indian deaths could be prevented or postponed with access to organ replacements.

That’s why the recent announcement of the first successful human transplant of an artificial heart in a US patient is such a big development. The artificial heart used in the transplant was created by medical technology company Carmat, which won FDA approval for human trials just last year.

ARTIFICIAL HEART SAVES A HUMAN LIFE

Carmat, which is based in France, received approval for its total artificial heart in late 2020. Now, half a year later, the first US patient has received one of the company’s hearts. It’s exactly what it sounds like: a heart made of synthetic and biological materials intended for implantation into people who need heart transplants.

The transplant took place last month in a 39-year-old man at Duke University Hospital in North Carolina. The man didn’t go to the hospital expecting to have a heart transplant, but it ended up saving his life.

After experiencing unexpected heart failure, he was diagnosed with advanced coronary artery disease (when plaque builds up in the blood vessels that carry oxygen-rich blood to heart) and went in for bypass surgery (which implants a healthy blood vessel from another part of the body to redirect blood around a blocked artery).

When his condition quickly worsened, his medical team realized bypass surgery wasn’t going to do it, but by that point a traditional heart transplant had become too risky. The patient was in the right place, because not just any transplant centre could have implanted an artificial heart.

Carmat got approval from the FDA last year to trial its heart in US patients with end-stage biventricular heart failure, a condition where the chambers that take in and push out blood stop working properly. Duke is one of just three transplant centres in the US participating in the trials, and the surgical team at the hospital had already undergone training for implanting the device.

The Surgery is to remove the left and right ventricles and then place the artificial heart in its place. The patient was “very stable” throughout the whole process.

HOW EXACTLY DOES CARMAT’S HEART WORK?

The artificial or “robotic” heart has a chamber for hydraulic fluid and one for blood, separated by a membrane. The blood-facing side of the membrane is made of tissue from a cow’s heart, as are the heart’s four valves. A motorised pump moves hydraulic fluid in and out of the chambers, and that fluid moves the membrane to let blood flow through. Embedded sensors automatically adapt blood flow to a person’s needs in any given moment. For example, if a person’s exercising, then blood flow will increase.

Components of Carmat’s total artificial “robotic” heart. Source: Carmat

It’s this aspect that has earned the Carmat heart the designation of “next-generation,” and is what differentiates it from the artificial heart made by American company SynCardia, which is a fixed-rate device, meaning the beats per minute will stay the same regardless of patient activity.

The device weighs 900 grams, or just under 2 pounds (about three times the weight of the average human heart). The external setup is a bit heavier; recipients will have to carry about nine pounds of equipment, including a controller, a bag of actuator fluid, and two battery packs.

In the case of the Duke patient, his artificial heart will stay remotely connected to the hospital’s system so that his doctors can monitor it and be sure it’s functioning as it should.

SO, WHAT HAPPENS NEXT?

Well, just days after the US transplant, a similar transplant took place in Italy, marking Carmat’s first commercial sale of the heart (the difference being that this patient’s transplant was planned, not done as part of a trial or a last resort).

Ongoing trials of the artificial heart will study its use for both temporary purposes—while patients wait for a real heart—and as a long-term solution.

FINAL THOUGHTS

The excessive demand for donated organs, not only in India but globally, will only intensify as technologies like autonomous cars make the world safer, given that many organ donors result from car and motorcycle accidents. Safer vehicles mean fewer accidents and donations.

Yet organ regeneration and bioprinting represent just one of the three R’s of regenerative medicine: “Replace.” The other two are Replenish (using stem cells) and Rejuvenate (using young blood and parabiosis).

A dramatic extension of the human health span is just over the horizon. Soon, we’ll all have the regenerative superpowers previously relegated to a handful of animals and comic books.

What new opportunities will open up when anybody, anywhere, and at any time can regenerate, replenish, and replace entire organs and metabolic systems on command?