7 ms·

Saving children’s lives with world-first ‘dead’ heart transplants

72 points by blacktulip 6y ago

blacktulip 6y ago
twitter thread without a paywall: https://twitter.com/thesundaytimes/status/1363407247922110465 https://twitter.com/thesundaytimes/status/136340724792211046...
- sefrost 6y ago
  With The Times website, if you add an extra "/" at the end of the URL, it will bypass the paywall. i.e. https://www.thetimes.co.uk/article/nhs-saves-childrens-lives-with-world-first-dead-heart-transplants-b0httn8lb/ https://www.thetimes.co.uk/article/nhs-saves-childrens-lives...
  - hkt 6y ago
    Hilarious and brilliant tip, thank you!
deleted 6y ago
[deleted]
InfiniteRand 6y ago
The UK study seems to be the pioneer but it is worth noting that this procedure is also being tested out in the US now https://www.statnews.com/2020/01/16/heart-transplant-donation-after-cardiac-death/ https://www.statnews.com/2020/01/16/heart-transplant-donatio... It’s a good sign that the procedure is spreading
- emteycz 6y ago
  From their page it seems like it's from the US...? https://www.transmedics.com/ocs-hcp-heart/ https://www.transmedics.com/ocs-hcp-heart/ https://www.transmedics.com/our-company/ https://www.transmedics.com/our-company/
CapriciousCptl 6y ago
The device used is extraordinary. The US has been using it for a year and a half in adult trials. Transmedics also has devices for the lungs and liver. Livers and to a lesser extent lungs already get transplanted after cardiac death when they’re judged to be viable— the key being that this device could quality of those organs and therefore more could be transplanted! This could benefit a lot of people— not just hearts! https://www.transmedics.com/ocs-hcp-heart/ https://www.transmedics.com/ocs-hcp-heart/
iso1210 6y ago
This is the UK, so the parents would have ended up with a hospital bill of £0 and an ambulance bill of £0.
- intricatedetail 6y ago
  Bill is included in the income tax. Funnily enough it does not apply to people living off shares, they truly pay £0 or close.
  - geden 6y ago
    Dividends are mildly taxed now.
    - vidarh 6y ago
      Capital gains are. Dividends ends up effectively taxed similarly to income when you factor in that dividends are taxed after corporation tax. This is very intentional in that it closed much of the loophole of paying yourself via a limited company paying dividends. Still a bit cheaper but not much.
  - blacktulip 6y ago
    Do you mean stock dividends? They are taxed - and not lightly: https://www.gov.uk/tax-on-dividends https://www.gov.uk/tax-on-dividends
    - vidarh 6y ago
      Well, capital gains is taxed much lower. Also combined with the ISA limits (20k put into ISA's each year - do it every year and your returns start adding up), you can get quite significant returns without paying tax at all. The UK tax system looks a lot more progressive on the surface than it is once you earn enough to take advantage of the various tax breaks. That said, few people will pay nothing - what they won't be paying if they live off share return (be it dividends or capital gains) is national insurance. I'm assuming that's what the person you replied to meant. However that means nothing in terms of NHS funding any more, as NI just goes into the general treasury fund in practice. It's become part of a convenient fiction about UK tax rates, given that most people are unaware of the way NI is structured. In effect the "20%" marginal tax band is roughly 32% marginal when you factor in NI, and the "40%" marginal tax band is really 42%, and the 45% band is effectively 47%. The 20/40/45 looks a lot less progressive when it's actually about 32/42/47 (even less so when you factor in the many tax breaks those of us on the higher or additional rate can afford to take advantage of that lower earners can't)
spyridonas 6y ago
How do they know that the dead heart will not die again? Do they repair it before transplant ? Also shouldn't the heart be from an equally aged human?
- intricatedetail 6y ago
  The heart fills in a questionnaire using cut off aortas as bloody limbs.
  - TheAdamAndChe 6y ago
    This comment hurts the signal-to-noise ratio of this site.
    - slovette 6y ago
      This is probably THE most HN comment I’ve ever seen.
      - deleted 6y ago
        [deleted]
      - deleted 6y ago
        [deleted]
- CapriciousCptl 6y ago
  Broadly speaking, two types of death are recognized with organ donation. Brain death, where there's no brain function at all and cardiac death, where there's no cardiopulmonary function. Brain death in isolation generally provides the most viable organs, since it minimizes so-called "warm ischemia" time, which is the time that the organs are warm and without viable blood flow. However, sometimes patients don't meet brain death criteria strictly, or they do but the donor next of kin decides to donate after cardiac death (actually, the next of kin/family determines what the donor would have wanted and there is a strict legal/ethical precedence on what opinions count). In those cases, cardiac death is initiated by stopping life support and waiting 2-10 minutes after "death" to initiate organ harvest. So, it's not that the heart caused death, it's just that it stopped beating, generally, due to lack of oxygen. Which means some of its cells certainly died, but by minimizing the warm ischemia time (by hooking up to a kind of life-support machine), that damage can be limited. Patients do not have to matched strictly by age. Anatomically-speaking, body-size is the most important criterion. Obviously, matching needs to happen on antibodies/rejection and several other factors as well.
macksd 6y ago
In what sense were previous heart transplants not dead? Would they only use hearts that were kept pumping right up until they were surgically removed from the donor? I thought they were previously transported on ice, and assumed their must be some period of time during which the hard was considered dead - wondering what's so fundamentally different beyond the device that circulates donor blood through the heart.
- carbocation 6y ago
  I think this is an important question. Donation of organs after death can happen when people are declared dead due to brain death, or when they are declared dead due to classical criteria including cardiac death. "Donation after cardiac death", as you might imagine, seems a bit weird when the heart is the organ being donated. And so it's a recent invention for the heart (though it has been around for a long time for other organs such as the kidney[1]). There is a free access article from 2018 about the necessity and ethical considerations of cardiac donation after cardiac death in Circ: Heart Failure [2]. 1 = https://health.ucdavis.edu/transplant/nonlivingdonors/donation-after-cardiac-death.html https://health.ucdavis.edu/transplant/nonlivingdonors/donati... 2 = https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.118.004884 https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.118...
- pontifier 6y ago
  It seems like most other hearts were removed live after brain stem death. My take is that in this process, hearts that had stopped beating in a donor due to death from other causes were revived after removal.
- frosted-flakes 6y ago
  > Would they only use hearts that were kept pumping right up until they were surgically removed from the donor? Correct. I went through this with a family member who was struck by a car and later declared brain-dead in hospital—but his heart was still beating, and thus a candidate for heart donation. We said our final goodbyes before he was wheeled away for surgery, heart still beating and looking as alive as ever. The anonymous recipient underwent surgery simultaneously in the same hospital, so presumably the heart only stopped beating for a very short period of time before it was re-started, and it continues on beating to this day (it's a funny feeling, knowing that).
dm319 6y ago
Another relevant point is that England has changed its organ donation policy to opt-out [1], with Scotland to follow next month. Wales is 'deemed consent', which doesn't sound too different to opt-out. Northern Ireland is opt-in. [1] https://www.organdonation.nhs.uk/uk-laws/ https://www.organdonation.nhs.uk/uk-laws/
- teruakohatu 6y ago
  Unfortunately here in New Zealand we have essentially neither opt in or opt out. It is technically opt in, but if you opt in they wil only take them with family consent. So in effect it requires a pre and post death opt in. This puts grieving parents or other loved ones in a horrible position of having to make a decision concerning the person they just lost. It also means I don't have the final determination on my own organs. There is talk about making it opt out... But that would make it even less useful when next of kin get the final say.
  - williamdclt 6y ago
    Good reminder to talk about it (and other death-related things like funeral) with your family. They're more likely to respect your wish if you told them explicitely, than if a doctor they don't know tells them "they opted in, do you consent"
loloquwowndueo 6y ago
Click the link, content loads, then is immediately obscured by a “we need your consent” pop up. But content had already been loaded so why can’t I just read the thing? I have better things to do with my time. (Like whining here hahah).
- crazypython 6y ago
  I just use Bypass Paywalls[0] and Web Annoyances Ultralist (blocks cookie banners, autoplaying videos, sticky navs). https://jameslu.substack.com/p/hide-cookie-banners-paywalls-sponsored https://jameslu.substack.com/p/hide-cookie-banners-paywalls-... [0]: https://github.com/iamadamdev/bypass-paywalls-chrome/blob/master/README.md https://github.com/iamadamdev/bypass-paywalls-chrome/blob/ma... [1]: https://github.com/yourduskquibbles/webannoyances https://github.com/yourduskquibbles/webannoyances
neonate 6y ago
https://archive.is/AzPtF https://archive.is/AzPtF

72 points by blacktulip 6y ago

twitter thread without a paywall: https://twitter.com/thesundaytimes/status/1363407247922110465 https://twitter.com/thesundaytimes/status/136340724792211046...

sefrost 6y ago
With The Times website, if you add an extra "/" at the end of the URL, it will bypass the paywall. i.e. https://www.thetimes.co.uk/article/nhs-saves-childrens-lives-with-world-first-dead-heart-transplants-b0httn8lb/ https://www.thetimes.co.uk/article/nhs-saves-childrens-lives...
- hkt 6y ago
  Hilarious and brilliant tip, thank you!

deleted 6y ago

[deleted]

InfiniteRand 6y ago

The UK study seems to be the pioneer but it is worth noting that this procedure is also being tested out in the US now https://www.statnews.com/2020/01/16/heart-transplant-donation-after-cardiac-death/ https://www.statnews.com/2020/01/16/heart-transplant-donatio... It’s a good sign that the procedure is spreading

emteycz 6y ago
From their page it seems like it's from the US...? https://www.transmedics.com/ocs-hcp-heart/ https://www.transmedics.com/ocs-hcp-heart/ https://www.transmedics.com/our-company/ https://www.transmedics.com/our-company/

CapriciousCptl 6y ago

The device used is extraordinary. The US has been using it for a year and a half in adult trials. Transmedics also has devices for the lungs and liver. Livers and to a lesser extent lungs already get transplanted after cardiac death when they’re judged to be viable— the key being that this device could quality of those organs and therefore more could be transplanted! This could benefit a lot of people— not just hearts! https://www.transmedics.com/ocs-hcp-heart/ https://www.transmedics.com/ocs-hcp-heart/

iso1210 6y ago

This is the UK, so the parents would have ended up with a hospital bill of £0 and an ambulance bill of £0.

intricatedetail 6y ago
Bill is included in the income tax. Funnily enough it does not apply to people living off shares, they truly pay £0 or close.
- geden 6y ago
  Dividends are mildly taxed now.
  - vidarh 6y ago
    Capital gains are. Dividends ends up effectively taxed similarly to income when you factor in that dividends are taxed after corporation tax. This is very intentional in that it closed much of the loophole of paying yourself via a limited company paying dividends. Still a bit cheaper but not much.
- blacktulip 6y ago
  Do you mean stock dividends? They are taxed - and not lightly: https://www.gov.uk/tax-on-dividends https://www.gov.uk/tax-on-dividends
  - vidarh 6y ago
    Well, capital gains is taxed much lower. Also combined with the ISA limits (20k put into ISA's each year - do it every year and your returns start adding up), you can get quite significant returns without paying tax at all. The UK tax system looks a lot more progressive on the surface than it is once you earn enough to take advantage of the various tax breaks. That said, few people will pay nothing - what they won't be paying if they live off share return (be it dividends or capital gains) is national insurance. I'm assuming that's what the person you replied to meant. However that means nothing in terms of NHS funding any more, as NI just goes into the general treasury fund in practice. It's become part of a convenient fiction about UK tax rates, given that most people are unaware of the way NI is structured. In effect the "20%" marginal tax band is roughly 32% marginal when you factor in NI, and the "40%" marginal tax band is really 42%, and the 45% band is effectively 47%. The 20/40/45 looks a lot less progressive when it's actually about 32/42/47 (even less so when you factor in the many tax breaks those of us on the higher or additional rate can afford to take advantage of that lower earners can't)

spyridonas 6y ago

How do they know that the dead heart will not die again? Do they repair it before transplant ? Also shouldn't the heart be from an equally aged human?

intricatedetail 6y ago
The heart fills in a questionnaire using cut off aortas as bloody limbs.
- TheAdamAndChe 6y ago
  This comment hurts the signal-to-noise ratio of this site.
  - slovette 6y ago
    This is probably THE most HN comment I’ve ever seen.
    - deleted 6y ago
      [deleted]
    - deleted 6y ago
      [deleted]
CapriciousCptl 6y ago
Broadly speaking, two types of death are recognized with organ donation. Brain death, where there's no brain function at all and cardiac death, where there's no cardiopulmonary function. Brain death in isolation generally provides the most viable organs, since it minimizes so-called "warm ischemia" time, which is the time that the organs are warm and without viable blood flow. However, sometimes patients don't meet brain death criteria strictly, or they do but the donor next of kin decides to donate after cardiac death (actually, the next of kin/family determines what the donor would have wanted and there is a strict legal/ethical precedence on what opinions count). In those cases, cardiac death is initiated by stopping life support and waiting 2-10 minutes after "death" to initiate organ harvest. So, it's not that the heart caused death, it's just that it stopped beating, generally, due to lack of oxygen. Which means some of its cells certainly died, but by minimizing the warm ischemia time (by hooking up to a kind of life-support machine), that damage can be limited. Patients do not have to matched strictly by age. Anatomically-speaking, body-size is the most important criterion. Obviously, matching needs to happen on antibodies/rejection and several other factors as well.

macksd 6y ago

In what sense were previous heart transplants not dead? Would they only use hearts that were kept pumping right up until they were surgically removed from the donor? I thought they were previously transported on ice, and assumed their must be some period of time during which the hard was considered dead - wondering what's so fundamentally different beyond the device that circulates donor blood through the heart.

carbocation 6y ago
I think this is an important question. Donation of organs after death can happen when people are declared dead due to brain death, or when they are declared dead due to classical criteria including cardiac death. "Donation after cardiac death", as you might imagine, seems a bit weird when the heart is the organ being donated. And so it's a recent invention for the heart (though it has been around for a long time for other organs such as the kidney[1]). There is a free access article from 2018 about the necessity and ethical considerations of cardiac donation after cardiac death in Circ: Heart Failure [2]. 1 = https://health.ucdavis.edu/transplant/nonlivingdonors/donation-after-cardiac-death.html https://health.ucdavis.edu/transplant/nonlivingdonors/donati... 2 = https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.118.004884 https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.118...
pontifier 6y ago
It seems like most other hearts were removed live after brain stem death. My take is that in this process, hearts that had stopped beating in a donor due to death from other causes were revived after removal.
frosted-flakes 6y ago
> Would they only use hearts that were kept pumping right up until they were surgically removed from the donor? Correct. I went through this with a family member who was struck by a car and later declared brain-dead in hospital—but his heart was still beating, and thus a candidate for heart donation. We said our final goodbyes before he was wheeled away for surgery, heart still beating and looking as alive as ever. The anonymous recipient underwent surgery simultaneously in the same hospital, so presumably the heart only stopped beating for a very short period of time before it was re-started, and it continues on beating to this day (it's a funny feeling, knowing that).

dm319 6y ago

Another relevant point is that England has changed its organ donation policy to opt-out [1], with Scotland to follow next month. Wales is 'deemed consent', which doesn't sound too different to opt-out. Northern Ireland is opt-in. [1] https://www.organdonation.nhs.uk/uk-laws/ https://www.organdonation.nhs.uk/uk-laws/

teruakohatu 6y ago
Unfortunately here in New Zealand we have essentially neither opt in or opt out. It is technically opt in, but if you opt in they wil only take them with family consent. So in effect it requires a pre and post death opt in. This puts grieving parents or other loved ones in a horrible position of having to make a decision concerning the person they just lost. It also means I don't have the final determination on my own organs. There is talk about making it opt out... But that would make it even less useful when next of kin get the final say.
- williamdclt 6y ago
  Good reminder to talk about it (and other death-related things like funeral) with your family. They're more likely to respect your wish if you told them explicitely, than if a doctor they don't know tells them "they opted in, do you consent"

loloquwowndueo 6y ago

Click the link, content loads, then is immediately obscured by a “we need your consent” pop up. But content had already been loaded so why can’t I just read the thing? I have better things to do with my time. (Like whining here hahah).

crazypython 6y ago
I just use Bypass Paywalls[0] and Web Annoyances Ultralist (blocks cookie banners, autoplaying videos, sticky navs). https://jameslu.substack.com/p/hide-cookie-banners-paywalls-sponsored https://jameslu.substack.com/p/hide-cookie-banners-paywalls-... [0]: https://github.com/iamadamdev/bypass-paywalls-chrome/blob/master/README.md https://github.com/iamadamdev/bypass-paywalls-chrome/blob/ma... [1]: https://github.com/yourduskquibbles/webannoyances https://github.com/yourduskquibbles/webannoyances

neonate 6y ago

https://archive.is/AzPtF https://archive.is/AzPtF