TORONTO — A Toronto hospital says it has transplanted a heart that stopped beating last month for the first time in Canada, potentially significantly shortening the long wait for a donor.
The University Health Network says the procedure could increase the national donor pool by 30 percent if the practice were expanded nationwide.
This is the case in parts of Europe and Australia, where the practice was adopted ten years ago.
Dr. Seyed Alireza Rabi led the September operation in Toronto after being involved in one of the first non-beating heart transplants in the United States in 2019.
He was recruited from Massachusetts General Hospital, where he had performed similar heart transplants more than 50 times, but Lavi said he still considers it a miracle every time a donor's heart begins beating inside another person.
Here's how it works:
Typically, a heart transplant is performed when the donor is considered brain dead but his heart is still beating. The surgeon removes the donor heart, cools it and places it in a special preservative solution. It can stay outside the body for about four hours if on ice, and even longer if using temperature control technology.
The process is similar to the transplant performed at UHN last month (called a post-death circulatory criteria (DCC) heart transplant), but the donor's condition is different.
The patient has preserved basic brain function, such as very limited reflexes, but there is no prospect of neurological recovery. If a family decides to take their loved one off life support, they will be considered a candidate and will only be approached by the transplant team once that decision has been made so as not to influence them.
After the donor dies, Lavi said his team has one hour to transfer the heart from the donor to the recipient. After this hour, it will no longer be considered viable.
His surgical team quickly takes the donor to the operating room, cuts open his chest and removes his heart. They wash it in a protective solution and monitor the temperature of the organ. During this period, the heart is still warm, although it is no longer receiving oxygen and nutrients from the body.
Lavi then moves to the other side of the operating room and attaches the donor heart to a lung-heart machine that is already connected to the recipient. Blood and oxygen enter the heart, and it begins to beat even before it is sewn into the body.
But before that happens, Lavi says, there is a brief period of nervous uncertainty as he waits for the heart to awaken in its new body.
“Here's a heart that you take out of a person. It stops beating, it's cold, it's four to ten degrees Celsius. You put it back, you put it in, you sew it into a new person. It's exposed to a whole new environment, a new blood flow. And now you're hoping that it will start beating again, and not just beating, but beating to the point where it can support another person,” Laby said.
The hospital said the recipient in this case is recovering.
Here's why it's necessary:
UHN Chief Surgeon Dr. Thomas Forbes said there are currently more than 175 people on the waiting list for heart transplants in Canada.
“This innovation essentially increases the number of hearts available for donation… unfortunately, there is a shortage of organs to save these patients with end-stage heart failure.”
Researchers in Quebec found that the average wait time for a heart transplant in the province in 2022 was 342 days, and one in four adults on Canada's waiting list either dies or becomes ineligible for a transplant due to deteriorating health.
In 2024, 13 people died while waiting for a heart transplant, according to the Canadian Institute for Health Information.
Over the next year, UHN hopes to perform 10 to 15 additional heart transplants using this method, according to Forbes.
“We want to obviously look very closely at the outcomes and the benefit to patients, the importance of appropriate patient selection, both on the donor side and on the recipient side. And I think there will be a slow increase year after year.”
This report by The Canadian Press was first published Oct. 11, 2025.
The Canadian Press' health coverage is supported through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
