Hershey Medical Center is first in PA to use revolutionary new device to transport donor hearts
It looks like a white box on wheels. It weighs less than 20 pounds. Yet on the inside, the Paragonix SherpaPak Cardiac Transport System harnesses technology that revolutionizes the way hospitals receive donor hearts for transplant.
The Heart Transplant Program at Penn State Health Milton S. Hershey Medical Center is the first in Pennsylvania and the 24th nationwide to use the device. SherpaPak successfully transported four donor hearts to recipients at the Milton S. Hershey Medical Center from April to June, and the transplant team was so impressed by the results, it intends to use the device to transport many more donor hearts.
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“From my perspective, the device is excellent,” said Dr. Balakrishnan Mahesh, the lead surgeon who transplanted the first donor heart received at Hershey Medical Center through SherpaPak. “The heart was nice and supple, meaning the organ was preserved much better than with previous methods.
“I have used this device for heart transplants previously in London, and the technology that has been utilized to create it continues to amaze me. I am delighted that we have access to the SherpaPak at Hershey Medical Center as well.”
Cleared by the U.S. Food and Drug Administration for use in 2018, the SherpaPak uses proprietary thermal cooling to keep hearts at a steady temperature ─ between 4 and 8 degrees Celsius ─ during transport from the donor hospital to the receiving hospital. A leak-proof canister nestled inside the device and a low-potassium organ perseveration solution protect the heart on its journey. Bluetooth-enabled technology allows transport teams to continually monitor the heart’s temperature en route.
Prior to SherpaPak, the Hershey Medical Center team — and most transport centers worldwide — transported donor hearts in ice-filled coolers. While triple-layer plastic bags and preservation solution inside those coolers helped protect the heart during transport, “You couldn’t really prevent the heart from making contact with the surrounding ice, which can cause freezing and irreversible cellular damage,” said Dr. Marilou Page, a heart retrieval surgeon at Hershey Medical Center.
That freezing and thawing can lead to a condition called primary graft dysfunction (PGD), a life-threatening complication of heart transplant surgery.
SherpaPak reduces the risk for PGD. A clinical study showed a 54% reduction in severe PGD post-transplant for hearts transported by SherpaPak compared to hearts transported with ice.
The SherpaPak system transports donor hearts in a leak-proof, temperature-controlled canister.
“If SherpaPak can help prevent even one patient from having complications after a heart transplant, that’s a big deal,” said Dr. Robert Dowling, the primary transplant surgeon for the second heart received at Hershey Medical Center using SherpaPak. Like Mahesh, Dowling was impressed with the condition of the donor heart the team retrieved with the device. “I felt like our recipient got a Superman heart,” he said. “It was uniformly cold with no ice spots or ice injury.”
The same study revealed two other potential advantages of SherpaPak — longer ischemic times (the time in between the removal of the heart and the restoration of blood supply to the organ) and reduced time on the transplant waiting list. Hearts in the SherpaPak cohort of the study showed a 31-minute increase in median ischemic time and 54% reduction in median time on the wait list.
“As our experience with the system grows, we hope to use SherpaPak to bring back donor hearts from farther afield,” Mahesh said. To ensure the best outcomes for donor hearts transported with ice, the transplant team had previously limited the ischemic time window to three hours. “I could see us procuring hearts from three-and-a-half to four hours away in the future,” Mahesh said.
The longest current ischemic time for heart preservation with the SherpaPak is more than seven hours (428 minutes), accomplished by practitioners at Stanford Medicine..
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