Heart transplant at Toronto General Hospital 1st for Canada

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As medical discoveries go, this is heartbreaking—or rather heartbreaking—news.

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Toronto General Hospital performed Canada's first heart transplant in early September after the donor's heart stopped beating.

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Traditionally, heart transplant were only possible from brain-dead donors while the heart continues to beat and receive oxygen.

This new procedure, called death by circulatory criteria (DCC), involves patients who have no chance of neurological recovery. Once life support is switched off with family permission, the heart stops beating, death is confirmed, and organs are quickly restored.

“The old fashioned way, a brain-dead donor is brain dead, the heart is still beating,” said Dr. Seyed Alireza Rabi, who led the University Health Network's multidisciplinary team that performed the more than seven-hour operation.

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“In a new way, by the time we take the heart, both the heart and the brain stop working.”

Although these hearts experience a short period of oxygen deprivation, advances in medical technology now allow them to successfully transplant into Canada.

“In 2014, the Australians did it,” Rabie said, “and then in 2015 in the UK, and then in 2019 it started in the US. There are certain technologies that we haven't had access to until now. And we still don't have access to some of these technologies, but in the last year or so there have been reports of performing various techniques to protect and preserve the heart that we could adopt and implement them here in Canada.”

DCC is projected to increase the heart donor pool by 30%.

“We therefore expect that there will be a 30% increase in heart transplants and donations using this technique,” ​​said Rabie, a cardiac surgeon at the UHN Peter Munk Heart Center.

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“And this is based on all the other countries and all the other regions that have started doing this. They have increased their donations by 20 to 40%. This is very important.”

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WAITING LIST DEATH RATE DECREASED 'SIGNIFICANTLY'

At the end of 2024, there were 155 adults and 29 children living in Canada. waiting for a heart transplantaccording to data collected by the Canadian Institute for Health Information (CIHI).

Lavi estimates the wait time to be on the list is 12 to 18 months, depending on blood type.

“(Other countries) have also significantly reduced mortality on waiting lists — so people who are waiting are getting sick and will die if they don’t get a heart,” Labi said.

“And we have the expected time that they wait for the heart to beat significantly. And now, because Australia has 10 years of outcome data, we know that the long-term survival of these hearts is the same as the traditional way. So we're not putting the recipient at risk.”

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Heart failure is the most common cause of hospitalization in Canada and the leading cause of death.

“The only way to cure heart failure is a heart transplant,” Lavi said.

The DCC heart transplant recipient in Toronto is recovering well, and more patients have since undergone the new procedure, Luby said. He praised the families for their decision to donate their loved one's heart.

“This is the worst time of their lives,” Lavi said. “So while they're grieving for their loved ones, they allow us to do our due diligence to make sure they have a good heart. That's really the only reason we can do this.”

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