“Heart in a Box,” a Novel Organ Care System for Heart Transplantation

As the global burden of heart failure continues to rise, heart transplantation-the only definitive therapy for heart failure-has become a major focus of clinical research aimed at increasing the availability of suitable donor allografts. Historically, heart transplantation has been limited to the availability of hearts obtained from donors after brain death within relatively short distances. The TransMedics Organ Care System (OCS) Heart is a novel technology that allows for portable extracorporeal nonischemic perfusion of the heart after the circulatory death of the donor. Often referred to as "Heart in a Box," the OCS Heart is a potential major advancement in heart transplantation because of its ability to preserve the heart in a metabolically active state after the circulatory death of the donor, allowing for longer-distance transport compared to traditional cold storage methods. Numerous randomized controlled trials studying the efficacy of the OCS Heart technology from donors after circulatory death compared to traditional cold storage methods from donors after brain death demonstrated noninferiority. By allowing for preservation after circulatory death and for longer transport times, the OCS Heart can potentially significantly expand the donor pool and increase the number of heart transplants. The major limitations of its use include the expensive costs of operation, the increased level of training required for personnel, and the risk of technological malfunctions compared to traditional cold storage methods. Nevertheless, the OCS Heart is poised as a critical development in the field of heart transplantation, with an expectation that adoption rates for its use will increase in the coming years.