Medical research
Aside from hearts being used in transplant, they are also commonly used in medical research(Frost and Sullivan 2017). In this paper, I will be evaluating the uses of hearts in drug testing and medical education. Drug testing is where a medical drug goes through a process of trialing to screen for efficacy, dosage, toxicity, and side effects the drug may have(Novartis 2016). Overall drug trials are used to see if a new medicine works as it should (NHS 2019). Medical education refers to where a medical practitioner research and test potential ways to improve care to patients and develop the direction of the medical industry(Lockton Health 2014).
Donor hearts are used in the preclinical stages of drug testing to test drugs for toxicity,efficacy and dosage. In 2020, NHS has announced their collaboration with Novartis, a pharmaceutical company, to create a brand new cholesterol treatment called Inclisiran to aid heart disease patients. So far, from clinical trials results showed that of the 300,000 heart patients supplied annually, it could prevent 55,000 patients from experiencing heart attacks and strokes. Inclisiran is a bi-annual injection which has been approved by the National Institute for Health and Care Excellence’s (NICE) so NHS England and Novartis will be able to make treatment widely available for heart patients as early as in 2021. The National Institute for Health Research (NIHR) supports the planning, preparation and delivery of the clinical research which is projected to cost £300 million each year. (GOV.UK 2020)
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Figure 9: Artificial hearts used for drug testing (NovoHeart) (Forbes, 2019)
Artificial organs have began to be used in the world of medical testing. Previously for many years, donor organs and animals have been the subject of drug testing for safety and efficacy. In 2014, Ronald Li, Kevin Costa and Michelle Khine founded NovoHeart, a global biotech firm, where an artificial heart made from stem cells was created to mimic real human heart responses to drugs.
After researching for 20 years, the production of this small-sized “heart-in-a-jar” was created. The way in which this heart was created was that the small jar is replicated to act as one of the chambers that make up the heart. So far, these artificially produced hearts have successfully been able to detect any cardiotoxic effect that heart drugs may have. A major benefit of these artificial hearts is that, NovoHeart have been able to make hearts that can carry genetic abnormalities so that during the clinical trials of the drug testing, pharmaceutical companies can test on hearts that actually require the drug which is usually in short supply, the latter being that actual heart patients are put at risk when testing the drug.
Kevin Costa, Cofounder of NovoHeart, told Forbes that he believed that artificial hearts and other produced organs are the solution to revolutionizing drug testing as the process is made more patient friendly, increases effectiveness and reduces wasted resources, such as donor organs to test drugs on. He also pointed out the lack of predictiveness that cell cultures and small animal have for presenting the effects cardiac drugs would have on human patients.
In comparison to traditional drug testing, using artificial hearts would increase the precision in results of how the drug will react to the heart and reduce drug trial times as result precision will show the accurate effects of the drug immediately and time spent searching for diseased hearts would be reduced as they can also be artificially produced. These are issues that pharmaceutical companies face when testing with real hearts which can now be seen as a waste of potential donatable transplant hearts and dangerous to put real patients at risk when participating in drug trials as testing on animals and donor hearts can prove to be ineffective.
However, donor hearts play a crucial role in educating medical students. In order for aspiring, future doctors to understand the anatomy of the heart and how to deal with heart implications, they would need to be able to study a real one and dissect it. Therefore, to replace donor heart completely would not be realistic as doctors still need to research natural hearts to understand heart related diseases or illnesses that the majority of people who have natural hearts could face.
Summary and Conclusion
Having considering the points above, the advantages and disadvantages of the different types of hearts will be weighted. Considering the positive impact that artificial heart transplants make by reducing the build up of heart transplant waiting lists, it leads to question that when such resources are available instantaneously, could they be used entirely as a replacement to donor hearts. By replacing door heart transplants with artificial hearts, the many people in line for a heart transplant, who expire waiting, would be eradicated as there would not be the need to wait so long. This shows a strong downside in using donor hearts in comparison to artificial hearts since the long waiting time makes donor hearts an unreliable source for transplants, especially with the current fatal complacency the NHS is facing.
On the other hand, it is difficult to say that artificial hearts could fully replace donor hearts as transplant organs since they are on average less efficient. While artificial hearts could, theoretically, have a lifetime of 4.5 years, it is not realistic to assume that they will as the average is much lower (130 days). When looking at the lifetime of donor heart transplants (75% lasting 5 years), it is clear to see that donor hearts are the more time-sustainable option which suggests that they cannot be replaced by artificial hearts. While donor hearts are affected by negative lifestyle factors, these negative factors can be avoided but lifestyle issues caused by an artificial heart, like in Jim Lynskey’s case, cannot be avoided and can make a living with an artificial heart very challenging. In terms of its function, both types of hearts work equally well to ensure the patient’s heart functions normally, as if it weren’t damaged.
However, evaluating the costs will give a clearer view as to whether artificial hearts could replace donor hearts. If the average lifetime of a Total Artificial Heart (TAH) was taken and divided by a year, 3 TAHs would be needed. Meaning that in one year, a heart patient using TAHs in America could spend up to $450,000 for regular transplants. If this were to occur for 5 years, the patient would spend $2,250,000. Now, comparing a patient with a donor heart transplant (assuming it lasts for an average of 5 years), they would spend a total of $1,412,500 (cost of heart and 5 years worth of immunosuppressants). Currently, this is not the case as artificial hearts are only used as temporary transplant replacements for donor hearts. Yet, it shows that , overall, to live artificial heart after artificial heart is not financially viable, thus, reduces the idea that artificial hearts could replace donor hearts.
A significant advantage for the use of artificial hearts in transplants is that the major issue in donor heart transplants, organ rejection, is eliminated. This makes artificial heart transplants easier to deal with as the patient with an artificial heart is at a reduced risk of transplant malfunction (body destroying the heart) and avoids the pain and possible seizures that come with it.
Lastly, artificial hearts have begun to play a larger in the development of drugs, with the potential to over take real hearts as they have been proven to be more accurate, cheaper, more sustainable and less likely to put drug testing volunteers at risk. However, without real hearts continuing to be studied, we would cease to understand new developments found in real hearts that could aid to cure cardiac issues like cardiovascular disease. Not only that but there are many non-transplant-related solutions to cardiac issues like getting stents (mesh cages to open the hearts blood vessels). Real hearts (donor hearts) could not be replaced by artificial hearts for medical research as future doctors would need real hearts to practice surgical procedures to treat the vast majority of people who don't live on artificial hearts.
It can be concluded that, although artificial hearts do play a key role in the development of the drug testing industry and have features that could resolve and simplify implication of heart transplants, they are simply not developed enough in terms of efficiency and the cost of them is currently not proportional to the return people would get from them. The idea that artificial hearts could replace the need to use donor hearts is not lost, as more research and trials could perfect any outstanding issues to make artificial hearts the more suitable option when considering between the two, whether that’s a patient needing a heart transplant or a pharmaceutical company deciding how they plan to put a cardiac treatment through drug trials.
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