Lorraine and Derk Sherren hold a photo of their son, Robbie. In the days since Robbie’s donation, the hearts of two other Ontario patients have been reanimated for transplant in the U.S. using the same portable equipment.Kingston Health Sciences Centre
For Lorraine and Derk Sherren, the unexpected death of their 40-year-old son was crushing enough on its own, but the tragedy felt compounded when the couple heard it wouldn’t be possible to donate his heart to someone in need.
The barrier to a heart donation was the fact that Robbie Sherren, a Special Olympics bowler who suffered an aneurysm in late April, fell just short of meeting the strict criteria for brain death as he lay in an intensive-care unit in Kingston. His pupils occasionally constricted when a light was shone in his eyes. He had no other signs of brain activity, and no hope of recovery.
A patient who isn’t officially brain dead can still donate organs after life support is withdrawn and his heart has ceased beating for five minutes. But, in Canada, a heart stopped in that fashion had never been reanimated for transplant – until Robbie’s grieving parents prevailed upon Kingston Health Sciences Centre to make it happen.
On May 7, after a whirlwind 24 hours of planning, the Kingston hospital granted emergency privileges to a team of American doctors toting a machine the Sherrens called the “heart-in-a-box,” a device that restarted their son’s heart outside his body and kept it warm and pumping until the organ could be transplanted into the chest of a patient in the United States.
Robbie “would have been ecstatic” to know his heart was the inaugural Canadian donation, Derk Sherren said. Robbie donated blood 121 times in his short life. His mother donated a kidney to his father.
In the days since Robbie’s donation, the hearts of two other Ontario patients have been reanimated for transplant in the U.S. using the same portable equipment, according to Vivek Rao, the surgical director of mechanical circulatory support at the Peter Munk Cardiac Centre, part of Toronto’s University Health Network.
Dr. Rao, a senior member of the largest transplant team in Canada, said the milestone donations were bittersweet because Ontario could have been transplanting hearts retrieved after circulatory death sooner, if not for what he described as an unnecessary government delay.
“It’s just frustrating for a transplant surgeon to see hearts in Ontario that could be used by Ontarians going to the States,” he said. “And that’s a purely bureaucratic decision.”
Robbie Sherren competes in Thunder Bay, Ont., in February, 2020. Mr. Sherren, a Special Olympics bowler, computer whiz, all-around adventurer, suffered an aneurysm in late April.Supplied
Dr. Rao said that Toronto General Hospital, where the Peter Munk Cardiac Centre is located, has been trying to start a program for heart donations after circulatory death since before the pandemic. The procedure has recently become routine in Britain, Australia and the United States, with studies showing that DCD hearts, as they’re known, work just as well as hearts retrieved and put on ice after a declaration of brain death.
In Canada, the number of donors who have had their organs retrieved after circulatory death has risen from 64 in 2013 to 258 in 2022, the most recent year for which the Canadian Institute for Health Information has published data. Such donors accounted for about one-third of the 827 deceased organ donors in Canada that year. But none were able to donate hearts.
After the worst of COVID-19 subsided, Toronto General was planning to purchase an Organ Care System, the device the U.S. team used to preserve and transport Robbie’s heart. Then the provincial agency Ontario Health stepped in and offered to foot the bill so the equipment could be used provincewide, Dr. Rao said. The Trillium Gift of Life Network, which oversees organ donations, is part of Ontario Health.
Dr. Rao shared e-mails with The Globe and Mail showing that, in January, Ontario Health officials at the last-minute cancelled a trip for a group of Ontario doctors who were scheduled to travel to Florida to a training centre run by TransMedics, the company that makes the Organ Care System.
Ontario Health postponed the trip, he said, because the agency’s procurement department determined it couldn’t purchase an Organ Care System without first running a competitive bidding process, despite there being no other heart donor-organ preservation and transport system licensed for sale by Health Canada.
In a statement on Wednesday, Ontario Health said that enabling heart donations after death determined by circulatory criteria is “an exciting positive step forward” for the province.
The agency confirmed that it issued a request for proposals in April that closed on Wednesday. “This procurement ensures due process, fairness and transparency, and is in line with Broader Public Sector procurement requirements,” the agency said in an unsigned e-mail.
Rather than waiting for Ontario Health to purchase the equipment, Dr. Rao said the clinical group driving the project thought it was a tragedy these hearts were going to waste and decided to offer them to transplant programs in the U.S.
That was the background that Lorraine and Derk Sherren couldn’t have known about as they sat by their son’s side in the ICU in Kingston.
“I held on to his hand almost all of that time for a week and a half,” Ms. Sherren said. Once, when she woke up after dozing off in the chair next to Robbie’s bed, “the nurse was hanging on to his hand in mine to make sure that I never lost grip.”
She continued to hold fast after Robbie, who never let his developmental delays keep him from being a computer whiz, star bowler and all-around adventurer, was unhooked from the machines. After his heart stopped, he was rushed to the operating room for organ retrieval. His heart and one of his kidneys have since been successfully transplanted.
Gordon Boyd, a critical-care physician who cared for Robbie at the end of his life, said it was deeply meaningful for everyone at Kingston Health Sciences to fulfill the Sherren family’s wishes.
“It was a highly, highly emotional event,” Dr. Boyd said. “There was not a dry eye in the crowd. We were very happy to be able to make this happen for the family.”