Transplant investigation sparks medical debate

Donor organs are few and far between Keystone

An inquiry into a bungled heart operation has sparked a debate about the possibility of transplanting an organ not compatible with a patient’s blood group.

Rosmarie Voser died in April last year after surgeons at Zurich University Hospital gave her an incompatible heart.

Investigators are looking into whether Marko Turina, the surgeon in charge of Voser’s operation, knowingly tried to rewrite medical textbooks by giving her an organ which was likely to be rejected by her immune system.

Turina has claimed he was not aware at the time of the operation that the patient’s blood group was incompatible with the heart, which came from a different blood-group donor.

Attempts to transplant incompatible hearts have traditionally been considered to be strictly taboo.

But leading transplant cardiologist Lori West told swissinfo that more and more surgeons were pushing back the boundaries and considering what was once thought to be medically impossible.

Challenging assumptions

According to West, the traditional medical assumption has been that an organ must be compatible with a patient’s blood type – and that there is no chance of survival if an incompatible heart is used on the operating table.

But she has carried out operations on children using incompatible hearts and says that a successful heart transplant involving an adult patient can no longer be ruled out.

“We are able to consider crossing barriers now which were once thought to be absolutely insurmountable, because technology has made new approaches possible,” she said.

West, who is the medical director of the heart-transplant programme at the Hospital for Sick Children in Toronto, Canada, said that operations involving children had proven to be successful because a child’s immune system has not yet developed the antibodies needed to attack an incompatible heart.

Adults are far more likely to reject an incompatible organ – with fatal results – unless steps are taken to deal with the antibodies.

“There are now ways of getting rid of these antibodies and there are also new ways of targeting the cells that produce them,” said West.

Successful transplants

Kidney transplants involving incompatible organs have been successfully carried out, but West points out that such operations are not as dangerous as those involving hearts.

“With a kidney transplant, if things go wrong you can always fall back on dialysis. If a heart-transplant operation fails, you’re going to lose your patient.”

It’s for this reason that West believes no surgeon has yet set out to perform a transplant operation on an adult using an incompatible heart.

“It’s not that the evidence says that it would be less successful. It’s just that the evidence simply isn’t there, because we haven’t been able to do it yet.”

She adds that it is only a matter of time before the evidence gathered from operations using kidneys will become “so compelling” that it will make “perfect sense” to move on to hearts.

“It would be very risky, but it’s no longer an absolute barrier.

“I mean, who would have thought all those years ago that we could take a kidney out of someone’s body and put it in someone else’s? And we’ve certainly come a long way since then.”

swissinfo, Ramsey Zarifeh

Key facts

Heart-transplant patient Rosmarie Voser died at Zurich University Hospital in April 2004.
The hospital’s transplant team said she had been mistakenly given a heart which was not compatible with her blood group.
Investigators are seeking to determine whether surgeons deliberately gave the patient an incompatible heart.