Hearts travel better in a box

The ideas and innovators shaping health care

Aug 22, 2024 View in browser   By Erin Schumaker, Carmen Paun, Daniel Payne and Ruth Reader OPERATING ROOM When transporting hearts, the container matters, a new study found. | Sean Gallup/Getty Images Heart transplant recipients remain at risk of heart failure after surgery. But the risk is lower if the donor organ is stored in a box instead of a cooler, new research suggests. How’s that? It’s a special box. Time is of the essence during an organ transplant. The donor match, organ transport and surgery must happen within four hours to avoid an increased risk of health complications. Donor organs are traditionally kept in a potassium solution at 4 degrees Celsius in a cooler with ice. In the heart-in-a-box, or hypothermic oxygenated machine perfusion method, the resting heart is kept at 8 degrees Celsius and pumped with oxygen and fluids during transport. Using that method more than doubles the time transplant teams have to transport a donor heart. The evidence: In a randomized controlled trial published in The Lancet this month, researchers compared the outcomes of 204 adult patients, divided into two groups, who received heart transplants across 15 clinics in eight European countries. Half of the patients received hearts transported using the standard cold-storage method, while the other half received hearts kept in a box. The findings suggest a significant reduction in severe heart failure risk for patients who received hearts transported in the box. Specifically, the risk was 11 percent for the heart-in-a-box recipients compared with 28 percent for cold-storage recipients. What’s next? Study investigator Göran Dellgren said the results could transform the field. “Used correctly, the heart-in-a-box can reduce a number of complications that otherwise often result in suffering, poor outcomes, in the worst cases premature death, and also high costs,” Dellgren, a transplantation surgery professor at Sahlgrenska Academy at the University of Gothenburg and a cardiothoracic surgeon at Sahlgrenska University Hospital, said in a statement. “It is also likely that we can start using less ideal organs from older donors, which could increase the number of heart transplants.” WELCOME TO FUTURE PULSE Brooklyn, N.Y. | Erin Schumaker/POLITICO This is where we explore the ideas and innovators shaping health care. People with severe brain injuries thought to be incapable of understanding speech may be listening, even if they cannot respond, according to a new Mass General Brigham study that used advanced tools to measure their brain activity. Share any thoughts, news, tips and feedback with Carmen Paun at cpaun@politico.com, Daniel Payne at dpayne@politico.com, Ruth Reader at rreader@politico.com, or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp.  AROUND THE NATION Remote monitoring could enable more people with methadone prescriptions to take it at home. | AP People receiving methadone for opioid use disorder must often visit a clinic every day to ensure the drug isn’t diverted into the illicit market. It’s a hassle that many addiction specialists believe keeps people from the care they need. Now some providers are experimenting with remote monitoring to reduce patients’ burden. Instead of coming into a clinic, they’re allowed to take home a few doses and send a recording to prove they took them as directed. “Sonara, by offering remote observation of take-home methadone, creates this layer of supervision to what was previously unsupervised, and that is able to build trust between the provider and the patient,” said Sheeba Ibidunni, vice president of Sonara Health, one of the companies experimenting with the new protocol. Billionaire Mark Cuban was one of the first investors in the company, which got its first commercial contract in 2022. How it works: Patients can access Sonara through a web-based app that runs on smartphones. By logging in, scanning a QR code and displaying their methadone bottle to show it hasn’t been tampered with, they can record themselves taking their dose, Ibidunni said. Sonara partners with organizations offering free phones to those who don’t have one, she said. After taking their dose, patients must repeat a sentence to ensure they're not hiding methadone in their cheeks. They then send the video to their care team. Sonara is available in 35 methadone treatment centers spread across nine states, with up to 900 patients using it, according to Ibidunni. Dollars and cents: Many states’ Medicaid programs don’t cover the remote-monitoring service, so some treatment providers have used opioid settlement money – stemming from state lawsuits against the makers of prescription opioids – to pay for it, Ibidunni said. She said the firm is lobbying state officials to fund pilot programs, which she said will show that the method saves money by reducing nonemergency medical transportation, which Medicaid covers. The lobbying led New Jersey to appropriate $250,000 in funding for Sonara in fiscal 2025. Ibidunni hopes this will lead the state’s Medicaid program to cover the service in the future. Separately, the National Institute on Drug Abuse is funding a project that’s assessing the results of a remote monitoring system for methadone. FUTURE THREATS Is than an AI model you're examining? | AP Photo The U.S. should come up with rules for artificial intelligence models that pose the greatest risks to humankind, a former Biden administration official and nearly a dozen other researchers with expertise in biosecurity, biology, global health and artificial intelligence write in Science today. Why it matters: AI models trained on biological data could create deadly pathogens, warn researchers from Stanford University, Johns Hopkins Bloomberg School of Public Health and Fordham University. “We don’t want to be in a place where tools are suddenly that capable and are not on the radar screen of our government,” said Dr. Tom Inglesby, who leads the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health and was one of the paper authors. He was the Covid-19 testing czar in the White House from 2021 to 2022. Regulators should assess high-risk models before they’re released, Inglesby and the other authors argue. This evaluation should test whether a model could plausibly increase a pathogen’s transmissibility or virulence, they write. Regulation should also dictate whether the models are publicly available or whether access is restricted, Inglesby said. What’s next? “If we do that right in the U.S…. then we have the ethical and reasonable standing to try to argue that other countries take a similar approach,” Inglesby said.   Follow us on Twitter Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker   Follow us

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