Toronto Hospital Achieves Landmark Heart Transplant Using Non-Beating Organ
A hospital in Toronto has achieved a groundbreaking milestone by successfully transplanting a heart that had stopped beating, marking a first for Canada. The University Health Network (UHN) reported that this innovative procedure could potentially expand the national donor pool by 30% if implemented nationwide, aligning Canada’s practices with those in some European countries and Australia that adopted similar methods a decade ago.
The September surgery was led by Dr. Seyed Alireza Rabi, who previously participated in one of the first heart transplants involving a non-beating heart in the United States back in 2019. Having performed over 50 such transplants at Massachusetts General Hospital, Rabi expressed a deep sense of awe at the miracle of a donor's heart starting to beat within a new recipient.
Understanding the Procedure
Traditionally, heart transplants are conducted when a donor’s brain death has been confirmed, but their heart continues to beat. In this standard procedure, the surgeon carefully removes the heart, cools it, and places it in a specialized preservative solution, allowing it to remain viable for about four hours on ice, or even longer with advanced technology.
In the recent transplant at UHN, known as a donation after death by circulatory criteria (DCC) heart transplant, the donor's situation was slightly different. The donor had underlying brain function—exhibiting minimal reflexes—but faced no possibility of neurological recovery. Family members considering withdrawal of life support would be approached only after their decision, ensuring that the transplant team's involvement would not sway that difficult choice.
Upon the donor's death, Dr. Rabi and his team had a one-hour window to transfer the heart to the recipient. Exceeding this timeframe would render the organ unsuitable for transplant. The surgical team swiftly transported the donor to the operating room, where the heart was extracted, flushed with a protective solution, and its temperature managed. At that point, while the heart was warm, it was no longer receiving oxygen or nutrients from the body.
Once the heart was ready, Dr. Rabi moved to the other side of the operating room to attach it to a heart-lung machine that was already linked to the recipient. Blood and oxygen flowed into the heart, which began to beat even prior to being sewn into the recipient's body. Rabi conveyed the anxiety that accompanies this moment, stating, “Here is a heart that you’re taking out of a person. It stops beating, it’s cold...and now, you’re hoping that it will start beating again.”
The hospital announced that the recipient of the transplant is currently recovering well from the surgery.
The Need for Innovation
Dr. Thomas Forbes, UHN’s surgeon-in-chief, highlighted the ongoing need for innovative transplant procedures, noting that over 175 individuals are presently on the waiting list for heart transplants across Canada. He underscored that this new practice has the potential to significantly increase the availability of donor hearts to combat the pressing shortage of organs for patients facing end-stage heart failure.
In Quebec, researchers reported that the average wait time for a heart transplant reached 342 days in 2022. Alarmingly, up to one in four adults on the waiting list could die or become ineligible due to declining health. Reports from the Canadian Institute for Health Information indicated that 13 individuals died while awaiting heart transplants in 2024.
Looking forward, Dr. Forbes anticipates that UHN aims to conduct between 10 to 15 additional heart transplants utilizing this groundbreaking method within the next year. He emphasized the importance of closely monitoring outcomes while ensuring appropriate patient selection on both donor and recipient sides, indicating a gradual growth in the application of this technique.
The report concerning this historic transplant was initially published on October 11, 2025.
