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„A Cost-Benefit Analysis Has Not Been Prepared Yet”
Prof. Matthias Karck;
© University of Heidelberg
Matthias Karck is head of department of heart surgery at the University Hospital of Heidelberg. Since the beginning of the year, he has been testing a new transport system for donor organs. MEDICA.de talked to the expert about hearts beating outside the body and the high costs of the new transport box.
MEDICA.de: Mr. Karck, what is the problem with the transportation of donor organs?
Matthias Karck: Functioning organs must constantly be supplied with blood containing high levels of oxygen. However, the blood supply is interrupted in donor organs forcing the medic to react very quickly. Otherwise the organ may suffer damage after about ten minutes and as a consequence may die quite fast.
MEDICA.de: What possibilities exist to prevent such damages?
Karck: The standard procedure involves potassium containing liquid that is put on ice. This cools down the organs from body temperature which is about of 36.6 degrees to about four degrees centigrade with the result that metabolism decelerates and damages can be reduced. However, the organ must be cooled down immediately during the first minutes out of the body and it can only be transported safely for about four hours. If the transport takes more than four hours, this method unfortunately reaches its limitations.
MEDICA.de: You have been using a new transport system for donors’ hearts in your hospital since March 2009. The so called Organ Care System enables doctors to carry the organ in a box virtually by keeping it alive. How does the system work?
Karck: A perfusion pump is connected to the heart’s aorta - like a garden hose to a water pipe - which supplies the heart with the donor’s blood. The device works like a small heart-lung machine enabling the organ to keep up its beat even though it is in a box. At the same time, the system relieves the heart since it does not have to beat on its own. The device allows medics to transport organs for more than four hours, we actually assume that the organs may even last up to eight hours – depending on the type of organ.
MEDICA.de: Eight hours – is this really necessary in Germany? The distances here in Germany are not as far as for example in the USA where the system was developed.
Karck: In some cases, the system also makes sense here in Germany. In fact, organisations in Europe which distribute donor organs are well-connected and work quickly and structured, but it does happen that an organ is wasted because no suitable recipient lives nearby. This is very annoying because of the shortage of donor organs that we keep experiencing.
MEDICA.de: Does the system have a positive effect on the survival rate of the recipients when the organs are transported alive?
Karck: We do not really know but studies that are in progress will give us an answer to that question. Heart recipients probably get the most benefit out of the system since hearts suffer more from an interrupted blood supply than other organs such as the kidney or liver. Additionally, the system may be of help when transporting an organ from a donor that has not been healthy. We assume that the heart delivered with the new could work better after transplantation when compared to a delivery on ice.
MEDICA.de: This sounds promising. Why did it take such a long time to develop an alternative to the customary transport?
Karck: The transport on ice is very easy and has proven to work in many cases. Besides, it only costs 3,000 Euros. The Organ Care System, on the other hand, is technically very complicated. Doctors can only operate after previous training and the organ must be constantly supervised during the whole transport. This means that the system is quite expensive and also takes up a lot of staff working time.
MEDICA.de: Well, the system costs 80,000 Euros. Do you think that the application is profitable in spite of the high price?
Karck: A cost-benefit analysis has not been prepared yet. I assume that the device will be used as required when a longer transport is necessary or when the organs come from weakened or ill donors. In these cases, the system may really be beneficial. Being faced with shorter distances and healthy organs, nothing should speak against using the ice method.
The interview was conducted by Simone Heimann