The Current - A heart that stopped beating brought back to life

Episode Date: October 28, 2025

In a Canadian first, Toronto doctors have carried out a groundbreaking transplant with a heart that previously stopped beating. We talk to Dr. Ali Rabi, a member of the transplant team at Toronto's University Health Network about what was involved — and what this breakthrough means for the people on heart transplant wait lists.

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Donate at lovescarbro.cairbo. This is a CBC podcast. Hello, I'm Matt Galloway, and this is the current podcast. Debbie Bicco misses her son Tommy terribly, but she finds comfort in what happened after his death. Tommy was hilarious. He was a very caring person. He loved to help people.

And I know that right now he would be thrilled to know that he'd saved Lindsay's life. Tommy Bicko was 36 years old when he died from Trimmy. drug toxicity in 2020. A registered organ donor, Tommy was able to gift his heart, liver, and two kidneys to four people. Lindsay Ma received his heart. Lindsay is a two-time heart transplant recipient. Her first transplant was in 2012 when she was 28 years old. When that transplant failed eight years later, she needed a new heart and got Tommy's. Debbie and Lindsay eventually met up. Debbie was able to hear her son's heart beat again, and Lindsay was able to say thank you. I just really, really wanted to know where my heart came from and just thank them. Thank,

like, I'm just so, I'm so grateful. I opened the door and I just couldn't even talk. Yeah. Just had a hug and... A hug and... Wow. And it just felt like we were, we've known each other forever, like just family. Yeah. Come on in, sit down and have a beer. And we do, we do dinners quite often and but helps me keep Tommy. At the time of the transplant, Tommy's heart was kept being. when it was transplanted from his body to Lindsay's. That was the only option at that time, but not anymore. For the first time in Canadian history, surgeons in Toronto successfully transplanted a heart from a donor

after it had already stopped beating. It's called donation after circulatory death or DCD, and it could mean a big increase in heart transplants in Canada and lives saved. The operation was done at Toronto's University Health Network, led by Dr. Ali Robbie. the surgical director at the heart transplant program at Toronto General Hospital and an assistant professor of surgery at the University of Toronto. Dr. Rabi, hello. Good morning. Hi.

We are going to get to how this works in a moment, but you've actually done this surgery numerous times in the United States at Massachusetts General Hospital, but you're Canadian. I wonder what it meant to you to be part of this Canadian first. Yeah, I recently moved to Canada from the States And, you know, there is a clear gap in the number of transplants we do in Canada for our population. And one of the areas that was identified that needs advancement in Canada early on was that we don't do this type of transplant from disease donors. And so my recruitment and my coming here was part of that program to catch up that gap and be able to transplant more people here in Canada. So that was the understanding that I will be doing this given my experience. And, you know, when you're transplanting and when you're actually doing something in the operating room or planning for it,

you actually don't recognize really what is going on. You just sort of focus on the actual task at hand. But later on, I've had people coming up to me and telling me that, you know, other provinces, other places in Canada, they are really gearing up to do this. And I hope that this is going to be a start for us and catching up to our partner south of the border or elsewhere in the world in Australia and United Kingdom who have been doing this type of transplant for some time now. So I'm actually very excited about that opportunity. But, you know, as I said, I don't feel like there is any big difference for me when I'm actually doing the transplant. It feels routine.

I mean, I guess we would want you to stay calm and not have any extra butterflies. But I do want to be clear, like, this is a game changer to start using this procedure more widely in Canada. Is it not? Yes. So if you look at the data for any region, any country that had started using this type of heart for their patients, you expect the number of transplants to increase by anywhere between 20 to 40%. For Canada, I predict the number is going to be closer to 40% number in terms of the increase in number of transplants. And then on top of that, we get shorter weight.

list for people who are on the wait list. And, you know, these people are sick, the people who are waiting on the wait list for a long time. There is a significant amount of mortality associated with that. So also data shows that you reduce the number of mortality on the wait list for our recipients as this is happening. And then on the other side, you just had a really nice story about a mother of a donor. And I have to say, it's actually a relief for the donors or for the families of the donors who want to go through with the process. or transplant to know that we have the option of actually taking these hearts and transplanting them to someone else and extend their lives and having them go back to their families.

So I think even from the donor's side, there's a relief and understanding that now options are more. I mean, I have to say, as somebody who doesn't practice medicine, it's breathtaking to hear those two Debbie and Lindsay talking and imagine the real-life impact of this. but can you walk us through the DCD heart transplant? How do you recover and restart a heart that has stopped beating? Sure. So there are multiple technologies that you can utilize.

Basically, the fundamental difference between a DCD heart transplant and a brain dead donor, similar to what you just described from your previous guest, is that in a DCD or a circular death donor, there is a period of time that the heart has a stopped beating in the body and is not delivering oxygen to anywhere else in the body, including the heart itself. And that period of time can potentially be very damaging to the heart because your heart needs a lot of oxygen,

needs a lot of nutrients to actually pump. And so when it is not receiving the required amount of oxygen, it starts deteriorating. So we have to have a way of quickly recovering that heart, protect it, and then transport it in a safe way, a way that is potentially limiting the damage to the heart, and then transplanted as quickly as possible, so that once it is in the body, you know, the body can repair some of those damages. So the technologies we are using are basically have developed over the course of the last 10 years. And some of the techniques we used came from very recent publications as of last year or even last few months that came out of our collaborating partners in Vanderbilt. You mentioned you have to do this quickly. How much time do you have between when the heart is taken from the donor until it gets to its recipient?

Well, we limit at that time, the transportation time, to 45 minutes. So we said we are going to look at hearts that are very close to Toronto General Hospital. And so we put a limit on the geographical distance. And then when the heart gets into the operating room, everything should be ready. So there is a huge amount of collaboration and coordination going on with the recipient OR here back in our center, making sure that, you know, first of all, the recipient heart is out. the recipient is ready to be transplanted and everything is said. We can't waste time about that. So lots of coordination goes on. And then once the heart got back to the hospital here and in the operating room, we used a technique called beating heart transplant, meaning we profuse the donor heart

immediately from the blood coming out of the recipient and actually started beating. So we sewed the heart while it was beating. Oh my goodness. It's incredible. You mentioned that this uses new technology, and I wonder many people who live outside of the Toronto area may be wondering how quickly this kind of practice can spread across the country. How quickly could we see other health care facilities in Canada adopting it? Yeah, these technologies exist. These are commercially available devices. And some of them actually, we don't have access yet to the full extent of the technology here. in Canada. I'm hoping that in Ontario

will have access to it, hopefully by the end of the year. There are negotiations between the Ontario Health and the company that is selling those more advanced technologies that allows us to actually broaden the geographical extent, go outside of Toronto, go to Ontario, and even outside

of Ontario to the rest of Canada and event to the United States. There are currently examples of from U.S. coming to Canada and vice versa from Canada going to the U.S. So with these technologies, we will be able to do more of that, bringing hearts to our patients here, hopefully. And I think those technologies exist, and it just sort of is a matter of negotiating and getting access to them for the rest of the Canada.

And, of course, financial concerns and financial limitations are a concern. In terms of the patients themselves, how is the recipient of the first DCD heart transplant in Canada doing now? doing great he was telling me about his burger that he ate yesterday and he loved it is that recommended a burger after a heart transplant if it makes you happy sure is there data though about how patients generally fare after a transplant like this yes absolutely so there is actually a lot of data as I said some of the other countries have done this for some time so we have now 10 year follow

of data from Australia, which was the first country that started doing it back in 2014, 2015. And up to 10 years, there are no difference between the outcome in terms of recipients of the circular disease donor hearts and brain donor hearts. So up to 10 years, there are no difference. In the short term, there could be incidents of what we call primary graft dysfunction, which are basically when you put the heart in the heart as a slow to wake up. These are not rejections.

These are just a slow to adopting to the new environment. then we might have to use some pumps or circulatory devices to assist the heart for a period of time. But luckily all of those are limited and we can stop that and the heart starts beating independently and with normal function soon after. I wonder you talked about how when you're in the surgery, of course, you are laser focused on the surgery itself. But we've also discussed how this could really help with wait lists. And I wonder how it feels to be a medical practitioner and to think that, there are more possibilities now for helping people continue their lives. Well, this is great.

Actually, I feel very lucky and very fortunate, first of all, to be in a center that values so much about innovation and being in the forefront of medical technology and all the support that I'm getting here from all of my colleagues, the nurses, the perfusionist, anesthesiologist, everybody here is very supportive of everything. And, of course, the patients, both the daughter and the recipient's side, have been extremely generous and extremely good partners with us to make it work. But I think in general, around heart transplantation, we are currently in one of the transformative eras of heart transplant.

I would say, you know, with the beginning of heart transplant in 1967, there are two or three transformative eras. This is probably the third transformative era. In five years, heart transplant will be completely different than the way we are doing it right now. Of course, there's junior transplantation on the horizon. and there are so many other technologies and advances in heart transplant coming up. So I'm very excited to be in the field.

And for people who are looking into, you know, maybe choosing a career and doing it. And it's, of course, around transplantation, there are a lot of allied professionals that are helping us out. So I really encourage you to look into this field and the future is going to be very bright for our patients and for the field in general. Okay. Well, listen, it is extraordinary to hear about. and thank you for taking the time to tell us about it today. Congratulations, Dr. No problem. Thanks for having me. Have a good day. You as well. Dr. Ali Rabi is the surgical director at the heart transplant program at Toronto General Hospital and an assistant professor of surgery at the University of Toronto. This has been the current podcast. You can hear our show Monday to Friday on CBC Radio 1 at 8.30 a.m. at all time zones.

or you can also listen online at cbc.ca.ca slash the current or on the CBC Listen app or wherever you get your podcasts. My name is Matt Galloway. Thanks for listening. For more CBC podcasts, go to cbc.ca.ca slash podcasts.