For the first time in medical history, surgeons at National Taiwan University Hospital (NTUH) have successfully completed a heart transplant where the donor heart never stopped beating.

This landmark procedure skips what doctors call ischemic time, the usual pause in blood flow that occurs between the removal and implantation of a donor heart. In doing so, it offers a dramatic leap forward in preserving heart health and improving transplant success.

By keeping the heart continuously pumping oxygenated blood throughout the process, NTUH has set a new gold standard in cardiac surgery. The implications are global. For patients awaiting heart transplants, this could mean stronger hearts, fewer complications, and faster recovery.

In traditional procedures, a donor heart is put on ice immediately after removal. Though effective, this cold storage method cuts off oxygen supply to the heart, which can damage cardiac muscle cells even within the safe four-hour window. The longer the heart stays without oxygen, the higher the risk of post-transplant complications. But NTUH’s new approach replaces ice with innovation.

Enter the Organ Care System, a mobile device inspired by extracorporeal membrane oxygenation. This system acts like a portable life-support machine, continuously delivering oxygenated blood to the heart from donor to recipient. In a recent transplant, a 49-year-old woman with dilated cardiomyopathy became the first patient to receive a donor heart that remained beating from removal to implantation.

“The hearts were still beating before procurement, continued beating after procurement and never stopped,” said Chen Yih-shurng, head of NTUH’s organ transplant team.

Attending physician Chi Nai-hsin explained the significance further during a press conference in Taipei.

“We wanted to perform a heart transplant without any ischemic time so that the heart wouldn’t have to stop, and we could also avoid injury [to heart tissue] that typically occurs after reperfusion,” Chi said.

Chi emphasized that even though typical ischemic time is kept under four hours, eliminating it entirely provides the best possible outcome. Less damage means a lower chance of rejection, improved function, and a stronger prognosis for recovery.

“To keep the heart beating and avoid ischemia during the transplant procedure, the NTUH team drew inspiration from extracorporeal membrane oxygenation and designed a mobile organ care system that can continuously perfuse the heart with oxygenated blood,” Chi said.

The transplant was carried out in August after receiving approval from NTUH’s Research Ethics Committee. A video shown at the press conference revealed the beating heart connected to the machine as it traveled between operating rooms. Post-surgery, the patient resumed her daily life with minimal complications. Follow-up tests revealed low levels of cardiac enzymes, indicating that the heart muscle remained in excellent condition.

“We have demonstrated the safety and feasibility of the surgery,” Chi said.

A second transplant using the same system was completed earlier this year. Both cases are featured in a recent article titled “First-in-human Zero-Ischemia-Time Beating-Heart Transplant,” published by the Journal of Thoracic and Cardiovascular Surgery Techniques.

With more cases on the horizon, NTUH’s innovation may soon become the new norm in saving lives.