Abstract:
A device for arranging a harvested heart to be stored in an enclosure before transplantation, whereby the heart is connected to a tube for supply of a medical fluid to the heart. A cylindrical insert intended to be arranged in a enclosure for the heart, comprises a fixture for immobilizing the tube in a central position of the insert. The fixture comprises an arm extending from the periphery of the fixture to the center of the fixture; and a jaw device for gripping the tube and maintaining the tube and the organ hanging in the tube in a predetermined height position.

Description:
FIELD OF INVENTION 
       [0001]    The present invention relates to an device for maintaining an organ, such as a heart, viable and transportable for a long time, such as up to and exceeding 24 hours. In more detail, the invention relates to an insert for use in an organ transport device for transporting and storing of the organ before a transplant thereof. 
       BACKGROUND OF THE INVENTION 
       [0002]    U.S. Pat. No. 7,176,015 discloses a transportable organ preservation system for maintaining an organ viable for successful implantation into a human recipient. The system comprises a cylinder that contains 255 litre of oxygen sufficient for up to 34 hours of perfusion time. The organ is immersed in a perfusion fluid, which is oxygenated and pumped through the coronary vessels of the heart via the aorta of the heart in a retrograde flow. The system containing the heart, the oxygen cylinder, the pump assembly and hoses are all arranged in a tray, which is inserted in a commercial cooler device having cooling blocks and an insulation for maintaining the cylinder and the heart at a temperature of about 4° C. The sterility is maintained by a lid, which closes the cylinder. 
         [0003]    The patent publication WO 2011/037511 A1 discloses a method and a device for treatment of a heart after harvesting and before transplantation, in which a perfusion fluid is circulated through the coronary blood vessels of the heart. The perfusion fluid is cardioplegic and comprises an oncotic agent exerting an oncotic pressure larger than about 30 mmHg and the perfusion is performed at a pressure which is at least 15 mmHg and at least 15 mmHg lower than said oncotic pressure. The perfusion may be intermittent. WO 2011/037511 A1 is assigned to the assignee of the present application and its technical contents are included in the present application by reference. 
         [0004]    The patent publication WO 2012/128696 A1 discloses an apparatus for enclosing an organ after harvesting and before implantation, comprising: a vessel enclosing a fluid; a connection tube for connecting a fluid flow hose to the organ for passing a fluid to the organ by means of a pump. A degassing hose extending from the connection tube from a position adjacent the connection of the tube with an inlet part of the organ and to said vessel. A pinch valve is arranged in the degassing hose. During a degassing phase, the pinch valve is opened to allow fluid flow from the pump, via the fluid flow hose to the connection tube and via the degassing hose to the vessel for expelling air entrapped in the fluid flow system. A balloon is arranged to prevent fluid flow via the connection tube to the organ during the degassing phase. A sterility arrangement closes the vessel at the top thereof and may be replaced by a second, third etc. sterility arrangement without compromising the sterility. WO 2012/128696 A1 is assigned to the assignee of the present application and its technical contents are included in the present application by reference. 
         [0005]    There is a need in the art for an insert, which may facilitate the arrangement of the organ in a correct position in the organ transport system, which insert may be sterilized and be disposable. 
       SUMMARY OF THE INVENTION 
       [0006]    Accordingly, an object of the present invention is to mitigate, alleviate or eliminate one or more of the above-identified deficiencies and disadvantages singly or in any combination. 
         [0007]    According to a first aspect, there is provided a device for arranging a harvested organ to be stored in an enclosure before transplantation, whereby the organ is connected to a tube for supply of a medical fluid to the organ, comprising: a substantially cylindrical insert intended to be arranged in the enclosure for the organ; and a fixture for immobilizing the tube in a central position of the insert. 
         [0008]    According to an embodiment, the fixture may comprise an arm extending from the periphery of the fixture to the center of the fixture; and a jaw device at the arm for gripping the tube and maintaining the tube in a predetermined height position. In addition, there may be arranged a locking jaw for co-operation with the jaw device for locking the tube against unintentional withdrawal from the jaw device. 
         [0009]    According to another embodiment, the device may further comprise two ears arranged at the fixture for co-operation with openings arranged in the insert for maintaining the fixture in a predetermined position in relation to the insert. 
         [0010]    According to a further embodiment, the device may further comprise a lid arranged above the fixture for locking the fixture in position and for closing the space below the fixture. 
         [0011]    The organ may be a heart and the tube may be attached to an aorta residue of the heart. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0012]    Further objects, features and advantages of the invention will become apparent from the following detailed description of embodiments of the invention with reference to the drawings, in which: 
           [0013]      FIG. 1  is a schematic cross-sectional view of a prior art device for storage and transportation of an organ. 
           [0014]      FIG. 2  is a schematic perspective view partially in cross-section of an embodiment of the device according to the invention. 
           [0015]      FIG. 3  is a perspective view of an insert in the embodiment shown in  FIG. 2 . 
           [0016]      FIG. 4  is a perspective view of a fixture in the embodiment shown in  FIG. 2 . 
           [0017]      FIG. 5  is an exploded plan view of the fixture of  FIG. 4 . 
           [0018]      FIG. 6  is a plan view of the fixture according to  FIG. 4  in a locked position. 
           [0019]      FIG. 7  is a plan view of a lid in the embodiment shown in  FIG. 2 . 
           [0020]      FIG. 8  is a perspective view of the insert and fixture of the embodiment of  FIG. 2  and shows the insert and fixture in an initial position for gripping a tube with an organ hanging in the tube. 
           [0021]      FIG. 9  is a perspective view similar to  FIG. 8  with the fixture in a second position. 
           [0022]      FIG. 10  is perspective view similar to  FIG. 8  with the fixture in a third position. 
           [0023]      FIG. 11  is perspective view similar to  FIG. 8  with the fixture in place and a lid being arranged for closing the space. 
           [0024]      FIG. 12  is a perspective view similar to  FIG. 11  with the lid in a second position. 
           [0025]      FIG. 13  is a perspective view similar to  FIG. 11  with the lid in a final locked position. 
           [0026]      FIG. 14  is an exploded perspective view of an alternative embodiment of the device according to the invention. 
           [0027]      FIG. 15  is a plan view of the embodiment shown in  FIG. 14 . 
           [0028]      FIG. 16  is a partially cut perspective view of the embodiment shown in  FIG. 14  in an assembled state. 
           [0029]      FIG. 17  is a perspective view of the fixture in the embodiment shown in  FIG. 14 . 
           [0030]      FIG. 18  is a perspective view from below of the embodiment shown in  FIG. 14  and showing a support plate. 
           [0031]      FIG. 19  is a plan view of the support plate according to  FIG. 18 . 
           [0032]      FIGS. 20, 21 and 22  are plan views showing a lid to the fixture of the embodiment according to  FIGS. 14 and 17 . 
       
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
       [0033]    Below, several embodiments of the invention will be described. These embodiments are described in illustrating purpose in order to enable a skilled person to carry out the invention and to disclose the best mode. However, such embodiments do not limit the scope of the invention. Moreover, other combinations of the different features are possible within the scope of the invention. 
         [0034]    The below embodiments disclose apparatuses and methods for handling an organ between (and including) harvesting the organ in a donor and up to and including implant of the organ in a recipient. While the embodiments are described in connection with a heart to be transplanted, the same device may be used for other organs, such as lungs, liver and kidney. 
         [0035]    Most organs cannot withstand a long ischemic time, i.e. a condition without supply of nutrients and oxygen, which are normally supplied via the blood. For example, at normal temperature of 37° C., a heart cannot withstand more than about 20 minutes, while other organs, such as the lungs can withstand up to 40 minutes or more. 
         [0036]    The outcome of an organ transplantation is among others dependent on the condition of the organ before harvesting. All efforts should be undertaken to maintain the donor and its organs in as good a condition as possible before harvesting. Such efforts may for example include the method steps and processes disclosed in the patent publication WO 2010/077200 A1, the contents of which are included in its entirety in the present specification by reference. Generally, the methods of this publication involves that the potential donor is treated as vigorously as possible before death, and that circulation and ventilation are maintained after the time the potential donor is declared brain dead, in order to avoid ischemic conditions. After obtaining consent from the potential donor in advance and/or his/her next of kin, the potential donor is treated according to a strategy that maintains the organs in a viable condition, after brain death is declared. 
         [0037]    Next, the organs are harvested, most often within 24 hours after declaration of brain death. In some countries, brain death is not defined or authorized as indication of actual death. In such countries, the above-mentioned expression “declaration of brain-death” is intended to encompass any other definition of death or actual death, used in such country. For the purpose of the embodiments, brain death involves that the brain and the brain stem do no longer send any electric stimulation signals to the nerve terminals. 
         [0038]    The organs are examined for viability and stored, normally under hypothermic conditions until transplantation. 
         [0039]    Finally, the organs are implanted in the recipient. 
         [0040]    All steps are important for the final result of the organ transplantation. 
         [0041]    The present embodiments generally deal with the procedure between harvesting and implantation of an organ, especially of a heart. 
         [0042]    In a presently used procedure, the harvesting of a heart may start with exposing the heart to a cardioplegic and cold saline fluid, which is infused in the heart. The heart stops beating and the circulation stops. The heart may now be in the risk for an ischemic condition, since there is no blood flow. However, the infused fluid may provide sufficient oxygen and nutrients for avoiding ischemic conditions. The heart is made free from the donor and the aorta is cut and maintained with a sufficient length, called the aorta residue. 
         [0043]    The heart may be examined for viability, involving, for example, checking for aortic valve insufficiency and other examinations. Aortic valve insufficiency may be examined by adding a fluid to the aorta and examine whether the fluid level decreases. Since the fluid has no other escape way except via the aortic valve, this is a good test of the patency of the aortic valves. It is mentioned that the fluid may escape via the coronary vessels. However, the pressure for passing fluid through the coronary vessels is normally higher than a few centimeter of water pillar, which means that substantially no flow will pass through the coronary vessels during such an aorta valve test. The heart may also be examined by angiographic methods in order to detect defects in the coronary vessels and other problems. 
         [0044]    A connector tube is attached to the aorta and the heart is moved to a preservation apparatus and connected in a preservation circuit, for example as described in the above-mentioned U.S. Pat. No. 7,176,015 or the patent publication WO 2010/077200 A1. A preservation solution may be circulated through the coronary vessels via the aorta. The preservation is normally cold in order to cool the heart and maintain the heart in a hypothermic condition. Other strategies may as well be used. 
         [0045]      FIG. 1  discloses a device as shown in the prior art patent publication WO 2012/128696 A1 comprising a vessel enclosing a heart to be transplanted. The heart is immersed in a preservation solution. The heart is shown schematically with the a ventricle to the right in the figure and includes an aorta, ending in an aortic valve, which opens into a left ventricle of the heart. A mitral valve connects the ventricle with a left atrium. 
         [0046]    During normal operation in the living human body, blood enters the left portion of the heart via four pulmonary veins, one of which is shown in  FIG. 1 . The blood fills the left atrium and the left ventricle during diastole, while the mitral valve is open and the aortic valve is closed. During contraction, the left atrium is first contracted forcing further blood into the left ventricle. Then, the left ventricle is contracted, whereupon the mitral valve is closed and the aortic valve is opened and the blood is forced out into the body via the aorta. 
         [0047]    The right portion of the heart operates in a similar way, while blood enters the right atrium via two veins, superior vena cava and inferior vena cava. During diastole, blood fills the right atrium and right ventricle via tricuspid valve. During contraction of the heart, the blood in the right ventricle is forced to the lungs via pulmonary valve and pulmonary artery. 
         [0048]    The heart muscle is provided with blood supply via a left coronary artery and a right coronary artery, each dividing into capillaries. The coronary blood is returned to the right atrium via coronary sinus, which collects blood from several coronary veins, such as middle cardiac vein and great cardiac vein. The coronary sinus opens into the right atrium via Thebesian valve (not shown), which prevents backflow into the coronary sinus. 
         [0049]    During harvesting of the heart, the heart may be paralyzed via infusion of a cardioplegic fluid into the coronary circulation of the heart. The cardioplegic fluid is normally cold to induce a hypothermic condition in the heart. The aorta is cut in a position to keep it with a sufficient length so that a tube may be attached to the aorta for antegrade supply of coronary fluid flow. 
         [0050]    In  FIG. 1 , the heart  1  is shown removed from the donor and with a connection member such as a connection tube arranged in the aorta. The heart  1  is immersed in the vessel  2  so that the entire aorta is immersed below a fluid surface, in order to keep the aorta moist. There is only one connection required during the harvesting of the organ, namely between the connection tube and the aorta, which connection can be made relatively quickly. 
         [0051]    The connection tube is inserted in the aorta so that the end of the connection tube is above the aortic valve and the openings of the coronary arteries. The coronary arteries open normally between 5 and 10 mm above the aortic valve. Since the aortic valve is closed, all fluid passing through the connection tube flows through the coronary arteries. 
         [0052]      FIG. 2  discloses a modified enclosure for the organ according to an embodiment of the present invention. 
         [0053]    The enclosure  20  comprises a lower portion  21 , a first shoulder  22 , a second shoulder  23  and a third shoulder  24 . The third shoulder  24  is connected to a substantially rectangular rim  25 . The enclosure  20  fits in a box of the type disclosed in WO 2012/128696 A1. The box comprises pumps, cooling devices, oxygenator, tubes, valves etc for circulating a fluid. 
         [0054]    Inside said enclosure  20 , there is arranged an insert  30  according to an embodiment of the invention. The insert  30  rests on said first shoulder  22 . The insert  30  is provided with legs, one of which is visible in  FIG. 2 . There are four legs each arranged in a corner inside said rectangular rim  25  and along the side in order to immobilize said insert  30 . Thus, the insert is easily inserted into the enclosure  20  from above. 
         [0055]    The insert  30  accommodates a fixture  80  for a connection tube  81 , which is connected to the residue of the aorta  82  of the heart  83 . 
         [0056]    The insert  30  is shown separately in perspective in  FIG. 3 . 
         [0057]    The bottom portion of the insert  30  is formed of a lower cylindrical portion  35 , having a bottom rim  36 , which is arranged to rest on shoulder  22  or being arranged just above shoulder  22 . The lower cylindrical portion  35  is provided with four recesses  37  leaving an area for any fluid to pass from the space outside the insert  30  to the space below the insert  30 . 
         [0058]    An annular portion  38  is at its inner side connected to the lower cylindrical portion  35  and an upper cylindrical portion  39  is connected to the outside of the annular portion  38 . The upper cylindrical portion  39  is supported by said four legs  31 ,  32 ,  33 ,  34 . 
         [0059]    The upper portion of each recess  37  forms a shoulder  40 . Directly above each recess  37 , there is arranged an opening  41  having a substantially rectangular shape. Offset about 45° in relation to said openings  41 , there is a set of four slits  43 , each having a side entrance  44  via a recess  45 . 
         [0060]      FIG. 4  is a perspective view of a fixture  80  and  FIG. 5  is an exploded plan view of the fixture  80 . As clearly appears from  FIG. 5 , the fixture comprises four separate parts  83 ,  84 ,  85 ,  86 , which are joined to each other by three screws or rivets or similar means arranged in three holes  87 ,  88 ,  89 . The first upper part  83  of the fixture is annular over an arch of three quarter of a circle and has a dimension so that it may be arranged inside the insert  30  as shown in  FIG. 2  and resting on the shoulders  40  of each recess  37 . The upper part  83  comprises two ears  90  and  91  arranged at a mutual distance of 270° along the periphery of the upper part  83 . The ears  90  and  91  are dimensioned and arranged for fitting in two of the rectangular openings  41  while the rest of the fixture  80  rests on the shoulders  40 . 
         [0061]    In the centrum of the fixture, there is arranged a support jaw  92  at the end of an arm  93  extending from the central portion of the first part  83 . The support jaw  92  is dimensioned to enclose and retain a tube  81  as will be explained in more detail below. The jaw  92  extends over slightly more than 180° to grip the tube  81  with a friction grip. By this arrangement, the tube gripped by the support jaw  92  will be positioned in the middle of the enclosure  20 . A second part  84  is arranged below the arm  93  with a distance and has the same shape as the arm  93  and comprises a support jaw  94 . A third part  85  and a fourth part  86  are arranged between the arm  93  and the second part  84 . The fourth part  86  has a locking jaw  94  similar to the support jaws  92  and  94  but facing in the opposite direction. 
         [0062]    The fourth part  86  is pivotible between an open position as shown in  FIG. 4  to a closed position shown in  FIG. 6 . In the closed position, the fourth part  86  is locked by the third part  85  by a hook system  96 ,  97 . The hook system may be released by a lever  98 . 
         [0063]    Finally,  FIG. 7  shows a lid  101  to be arranged above support fixture  80 . 
         [0064]      FIGS. 8 to 13  explain the use of the described insert. 
         [0065]    In  FIG. 8 , the insert  30  is arranged in an enclosure (not shown) in the manner shown in  FIG. 2 . The residue of the aorta  82  of the heart has been connected to a tube  81 . 
         [0066]    The tube  81  is inserted in the support jaws  92  and  94  of the fixture  80  as shown in  FIG. 8 . The height position of the heart is adjusted as desired by moving the tube  81  in the height direction as seen in  FIG. 8 . Normally, it is desired that the heart hangs in the tube  81  slightly above the bottom of the enclosure  20 , but the user has full control of the height position and may choose another height position. 
         [0067]    When the desired position has been obtained, the locking jaw  95  is pivoted to a locked position shown in  FIG. 9 . The hook system  96  and  97  locks the fourth part  86  in the locked position. 
         [0068]      FIG. 10  shows the fixture  80  after being lowered and arranged in the insert  30 . The ears  90  and  91  of the fixture  80  are arranged in the rectangular openings  41  while the rest of the fixture rests on the shoulders  40 . If it is desired to adjust the position of the heart, this can be done by activating the lever  98 , thereby releasing the locking jaw  95 , whereupon the height position of the tube  81  and the heart can be adjusted up or down. Then, the lever  98  is moved to the locked position. 
         [0069]    It may be desired to arrange a lid  101  above the insert  30  as shown in  FIG. 11 . The lid comprises a slit  102 , arranged to pass the tube  81  from the periphery to the center of the lid  101 . Two grip holes  103  are arranged for handling the lid by two fingers of the user. In addition, there are four tabs  104  arranged equidistantly along the periphery of the lid. The lid and the tabs  104  are arranged and dimensioned to fit in the four slits  43  arranged in the insert  30 . The lid  101  is moved so that the tube  81  is arranged in the slit  102  and the tabs  104  are moved down the recesses  45  as shown in  FIG. 12 . 
         [0070]    Finally, the lid  101  is pivoted clockwise as shown in  FIG. 13  for moving the tabs  104  via the side entrances  44  into the slits  43 , wherein the lid  101  is locked in place and locks the fixture so that it cannot be removed. In the final position, the slit  102  of the lid is arranged above the arm  93 , so that no fluid may pass out through the slit  102 . 
         [0071]    The fixture  80  and the lid  101  may be arranged in four different positions displaced 90° in relation to each other. 
         [0072]    The fixture and lid are constructed so that they can be operated by one hand of the user, so that the user can use the other hand for manipulating the organ to a desired position. 
         [0073]    The tube  81  may be provided with a coupling (not shown) for connection to a tube system as shown in  FIG. 1 . The tube  81  may be connected to the tube system just below the bifurcation of the tubes shown in  FIG. 1 . Other arrangements may be foreseen, but such arrangements are not the subject of the present invention. 
         [0074]    The same system for circulating a fluid as disclosed in WO 2012/128696 A1 may be used in the device according the present invention. However, another circulation system may be used, and such systems are not the subject of the present invention. 
         [0075]    If two tubes are used as disclosed in WO 2012/128696 A1, such tubes may enter the insert  30  via two holes  46 ,  47  in the upper cylindrical portion  39  as shown in  FIG. 3 . 
         [0076]    The insert  30 , the fixture  80  and the lid  101  may be disposable parts used once and then discarded. The parts should be sterilized before use. 
         [0077]    A second embodiment of the device according to the invention is shown in  FIGS. 14 to 19 . The second embodiment comprises an enclosure  120  similar to the enclosure  20  and an insert  130  similar to insert  30 . 
         [0078]    The enclosure  120  is provided with an upper rim  125 , which is provided with a plurality of holes  126 . A rectangular plate  140  having the same plurality of holes  141  is attached to the enclosure  120  and is tightened to the enclosure by a plurality of screws, not shown. The rectangular plate is provided with a circular opening  142  having a slightly smaller dimension than the insert  130 . Thus, the plate  140  locks the insert in place. 
         [0079]    A circular rim or collar  150  may be inserted in the opening  142  for attaching a sterile cloth to the upper surface of the device. 
         [0080]      FIG. 15  shows the second embodiment in an assembled condition, from above, while  FIG. 16  is a broken perspective view, showing the enclosure  120 , the insert  130  and the fixture  180 . 
         [0081]      FIG. 17  shows the fixture  180  according to the second embodiment. In contrast to the fixture  80 , it does not have any moveable part, but the tube is kept in a central recess  181  by a friction grip. The fixture comprises four layers  182 ,  183 ,  184 ,  185 , each being provided with a recess  186 ,  187 ,  188 ,  189 . The recesses  187 ,  188  in the middle extend over 180° or slightly more, such as 185°, while the upper and lower recesses  189 ,  186  extend over a larger bow, such as 190° to 195°. Thus, a tube inserted in the recess is kept by friction by all four recesses and is stopped from passing out of the recesses mainly by the lower  186  and upper  189  recesses. 
         [0082]    Turning again to  FIG. 16 , there is shown a support plate  160 , which support plate is also shown in  FIGS. 18 and 19 . The support plate  160  comprises several holes and openings  161  for supporting devices, such as oxygenators, filters and tube sets etc. A circular opening  162  is arranged for fitting outside the bottom portion of the enclosure  120 . The inner periphery of the opening  162  is provided with several chamfered peripheral portions  163 , which fit into recesses  164  in the outer surface of the enclosure  120 , see  FIG. 16  and  FIG. 18 . 
         [0083]    As further shown in  FIG. 16 , the support plate  160  may support a stand  196  for supporting the fixture  180 ′ in a raised position. The distance between the raised fixture  180 ′ and the top surface of the enclosure is substantially the same as the depth of the enclosure  120 . The heart may be attached to the fixture  180 ′ in the raised position and the height position be adjusted to a desired position, whereupon the fixture  180 ′ is moved down to the final position shown by the fixture  180  in  FIG. 16 . In this manner, the distance between the heart and the bottom surface of the enclosure  120  can be adjusted in advance. The stand  196  may be attached to the support plate  160  as shown, or alternatively to the collar  150  shown in  FIG. 14 . The stand  196  may be removed after use. 
         [0084]    The raised position may be in relation to the top surface of the enclosure  120  as defined by the plate  140 . Alternatively, the lid  190  shown in  FIG. 20  may be put in place for defining the raised distance corresponding to the bottom of the enclosure. After the heart has been arranged in a desired position with the fixture in the raised position and with the lid in place, the lid is removed and the fixture is moved to the final position and the lid is again put in place now above the fixture and the heart. 
         [0085]      FIG. 20  shows a lid  190  similar to lid  101  shown in  FIG. 11 . However, lid  190  has a wider slit  191 . In addition, the lid has two grip holes  192 ,  193  and four tabs  194 .  FIG. 21  shows the lid arranged upon the fixture  180  in an initial position.  FIG. 22  shows the lid rotated so that a portion of the lid is positioned below a shoulder  195  of layer  185  of the fixture. In this position, the lid locks the tube in place as desired. 
         [0086]    In the claims, the term “comprises/comprising” does not exclude the presence of other elements or steps. Furthermore, although individually listed, a plurality of means, elements or method steps may be implemented by e.g. a single unit. Additionally, although individual features may be included in different claims or embodiments, these may possibly advantageously be combined, and the inclusion in different claims does not imply that a combination of features is not feasible and/or advantageous. In addition, singular references do not exclude a plurality. The terms “a”, “an”, “first”, “second” etc. do not preclude a plurality. Reference signs in the claims are provided merely as a clarifying example and shall not be construed as limiting the scope of the claims in any way. 
         [0087]    Although the present invention has been described above with reference to specific embodiment and experiments, it is not intended to be limited to the specific form set forth herein. Rather, the invention is limited only by the accompanying claims and, other embodiments than those specified above are equally possible within the scope of these appended claims.