Canada’s first non-beating heart transplant could lead to shorter wait lists: UHN

TORONTO — A Toronto hospital says it transplanted a heart that stopped beating last month in a Canadian first that has the potential to substantially shorten the long wait for a donor.

University Health Network says the procedure could grow the national donor pool by 30 per cent if the practice is expanded across the country.

That’s the case in some parts of Europe and Australia, where the practice was adopted a decade ago.

Dr. Seyed Alireza Rabi led the September surgery in Toronto after having been part of one of the first transplants with a non-beating heart in the United States in 2019.

He was recruited from Massachusetts General Hospital, where he performed heart transplants of this nature upward of 50 times, but Rabi said he still finds it a miracle every time a donor’s heart starts beating inside another person.

Here’s how it works:

Typically, heart transplants are performed when a donor is considered brain dead but their heart is still beating. The surgeon removes the donor heart, cools it and puts it in a special preservative solution. It can be out of the body for about four hours if it’s on ice, and even longer with temperature-controlling technology.

The process is similar with the transplant performed at UHN last month – called a donation after death by circulatory criteria (DCC) heart transplant – but the donor’s condition is different.

The patient has basic brain function, such as very limited reflexes, but there is no prospect of neurological recovery. If the family decides to take their loved one off of life support, they would be considered a candidate, only approached by a transplant team after that decision has been made so as not to influence it.

Once the donor dies, Rabi said his team has one hour to transfer the heart from donor to recipient. Beyond that hour, it would no longer be considered viable.

His surgical team quickly wheels the donor into the operating room, cuts open their chest and removes their heart. They flush it in a protective solution and control the organ’s temperature. During that window, the heart is still warm, even though it’s no longer receiving oxygen or nutrients from the body.

Rabi then shifts to the other side of the operating room and attaches the donor heart to a lung and heart machine that’s already connected to the recipient. Blood and oxygen flow into the heart and it starts beating, even before it’s sewn into the body.

But before that happens, Rabi said there is a brief period of nerve-racking uncertainty as he waits for the heart to wake up in a new body.

“Here is a heart that you’re taking out of a person. It stops beating, it’s cold, it’s at four to 10 degrees Celsius. You’re bringing it back, you’re putting it in, sewing it into a new person. It’s exposed to a whole new environment, a new blood flow. And now, you’re hoping that it will start beating again, and not just beating, but beating to a point where it can support another person,” Rabi said.

The hospital said the recipient in this case is recovering well.

Here’s why it’s needed:

UHN’s surgeon-in-chief Dr. Thomas Forbes said there are currently more than 175 people on the wait list for heart transplants in Canada.

“What this innovation provides is basically an increase in the number of hearts that are available for donation … unfortunately, there is a shortage of organs to save these patients with end-stage heart failure.”

Quebec researchers found the average wait time for a heart transplant in the province was 342 days in 2022, and as many as one in four adults on the waiting list in Canada either die or become ineligible because their health deteriorates.

Data from the Canadian Institute for Health Information shows 13 people died while waiting for a heart transplant in 2024.

Over the next year, Forbes said UHN is hoping to perform 10 to 15 additional heart transplants with this method.

“We want to monitor, obviously very closely, the outcomes and the benefit for the patients, the importance of appropriate patient selection, both on the donor and the recipient side. And I think year over year there will be slow growth.”

This report by The Canadian Press was first published Oct. 11, 2025.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

Hannah Alberga, The Canadian Press