Heart in a Box

By Meg Marinis, Director of Medical Research Nov 03, 2011
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Admit it. If you were sitting in the same room with Heart-in-a-box, you'd talk to her, too. And yes, it does deserve to be capitalized and treated as a proper noun – it's THAT cool. 

But before I begin my explanation of Heart-in-a-box, I first want to make something clear. The Heart-in-a-box is indeed a real thing. The heart that you saw inside of it on television? IS NOT A REAL HUMAN HEART. The TV heart was built by extremely talented people who work on "Grey's Anatomy." How? Well, I can't tell you all of our secrets, but I can tell you that the heart had a remote control that could make the heart beat. And it was awesome and very sci-fi.

How does it work?

Physically, the device appears quite similar to many other portable medical machines one might encounter in the hospital hallways. It stands about forty inches tall, thirty inches wide, and twenty inches deep. It's not super heavy – trained professionals can lift it up into the back of an ambulance or van.

And it can roll right into the operating room. During organ recovery, when the heart is removed from the donor's body, it is placed into the device's sterile chamber and immediately restarted to a warm beating state, like it never left the human body. How does it beat? The donor heart's aorta will be hooked up to tubing inside the machine and perfused with warm blood, taken from the donor during the recovery. The circulated blood gives the heart oxygen and nutrients to maintain function while the machine helps to filter out waste products. During transport, doctors continuously monitor the heart, checking temperature, rhythm, blood pressure, lactate levels, and other vital signs to make sure that the heart is healthy enough for transplantation.

Traditionally, donor hearts (and other organs) are placed on ice and are transported to the recipient in a cooler.

Transplanted hearts from coolers definitely save lives – there's no question. Surgeons cool the heart in order to prevent further damage from the lack of oxygen and nutrients that comes with the absence of a blood supply. However, cooling the organ carries some limitations. Damage to the heart cells still occurs, and therefore the heart will no longer be viable after six to eight hours outside a body. Due to the time constraint, doctors also do not have the ability to monitor important vital signs. They can only manage measurements such as blood type, weight, height, and gender to match donor to recipient.

The technology of Heart-in-a-box fixes the time limit. Now hearts could potentially remain viable for over ten hours, greatly increasing the donor pool for patients badly in need of a heart transplant. Also, the additional time gives the doctors the capability of performing more in-depth tests to assess the donor heart's function.

It is an experimental device.

In the United States, Heart-in-a-box has only been approved for use in clinical trials. A few medical centers across the country have already enrolled patients, performing approximately twenty warm beating heart transplants. However, Europe has already been using the technology commercially for a longer period of time with successful outcomes.