Dr. Seyed Alireza Rabi is part of the multidisciplinary team at the Peter Munk Cardiac Centre and the Ajmera Transplant Centre that is planning the first DCD – donation after circulatory death – heart transplant in Canada.Galit Rodan
Dr. Seyed Alireza Rabi specializes in a leading-edge procedure that allows hearts to be transplanted even after they have stopped beating
When Dr. Seyed Alireza Rabi left Toronto in 2006 for medical studies in the U.S., he had no idea he would one day find himself back in Canada, this time as a cardiac surgeon performing cutting-edge procedures at the country’s leading heart centre, University Health Network’s (UHN’s) Peter Munk Cardiac Centre.
Nor could he have predicted that he would someday be involved in a major advancement in the field of heart transplantation poised to save more lives in Canada.
In addition to his medical studies at Johns Hopkins University, Dr. Rabi pursued a Ph.D. in immunology, with a strong interest in organ transplantation. He was eventually drawn to the challenge and complexity of heart surgery – a pursuit that would change the course of his career.
“Heart surgery is about precision, about perfection,” says Dr. Rabi, who immigrated to Canada from Iran with his family at a young age. “Every millimetre of the heart is something that has to be respected and understood. And that aligns with my personality.”
Reshaping how heart transplants are performed
Dr. Rabi, who will also be director of heart transplantation in UHN’s Ajmera Transplant Centre – one of the largest organ transplant centres in North America – specializes in a leading-edge procedure that is new to Canada called donation after circulatory death (DCD).
DCD involves a donor whose heart has stopped beating, a process that was not possible in past because the organ could quickly become injured due to oxygen deprivation. Dr. Rabi honed his practice at Massachusetts General Hospital, one of two centres in the U.S. that pioneered DCD transplants and performed its first DCD heart transplant in 2020.
Most heart transplants use hearts from brain-dead donors with ongoing circulation. However, in some cases, the heart stops beating before donation, requiring careful assessment before transplantation. Innovative technology, known as ‘heart in a box,’ revives these hearts outside the body, restoring blood flow and oxygen to ensure their quality. This method, called ex vivo organ perfusion, was first advanced at UHN for lung transplants and is now helping expand the pool of usable donor hearts.
Dr. Rabi explains that a heart that stops beating would normally degrade quickly due to lack of oxygen, but the perfusion outside of the body process essentially reanimates the heart. “Then, we evaluate the heart [for metabolic and electrical activity] and make sure that it is still appropriate and acceptable for transplantation,” Dr. Rabi says.
He notes that while the very first heart transplant performed in 1967 by Dr. Christiaan Barnard in South Africa was in fact from a DCD donor. The modern era of DCD heart transplants took off in Australia in 2014 and was later implemented in the UK and U.S. He is honoured to be part of the multidisciplinary team at the Peter Munk Cardiac Centre and the Ajmera Transplant Centre that is planning the first DCD heart transplant in Canada.
“UHN and the Peter Munk Cardiac Centre have a very proud history with some of the most famous cardiac surgeons alive actively operating here,” says Dr. Rabi. “Dr. Tirone David is one of the giants of cardiac surgery and every surgeon in the world has learned about the pioneering techniques he developed in cardiac surgery. He has built a culture and a reputation of unparalleled innovation. Today, led by Dr. Maral Ouzounian, head of cardiovascular surgery, that innovation continues and is something I want to be part of.”
Dr. Barry Rubin, Peter Munk Cardiac Centre medical director, predicts that Dr. Rabi will transform the field of heart transplantation. “He is the rare combination of gifted technical surgeon and visionary researcher, and his expertise will improve the lives of patients with advanced heart disease at the Peter Munk Cardiac Centre and around the world. We look forward to working with him.”
Dr. Rabi adds that DCD transplants will significantly increase the number of heart transplants performed in this country, providing more Canadians with the organs they desperately need. “It is important to note that multiple studies following up the recipients of DCD hearts have assured us that the quality of these hearts is not jeopardized,” he says.
As of Dec. 31, 2023, 132 Canadians were waiting for a heart transplant, according to the Canadian Institute for Health Information.
“One million people are living with heart failure in Canada,” Dr. Rabi adds, noting that many of them will ultimately need more advanced therapies including transplant as their disease progresses, “but there aren’t enough hearts to go around.”
‘They’re happy and participating in life again’
Dr. Rabi estimates that DCD transplants will yield 30 per cent more hearts for transplantation, dramatically enhancing the lives of those living with heart failure.
Heart transplant recipients typically have improved physical capacity, enabling them to enjoy the activities and social interactions they may have previously had to miss out on.
“When we give them a new heart, these people go back to their communities, they go back to their lives,” Dr. Rabi says. “They are alive and happy and participating in life again.”
Dr. Rabi is also excited about future research into how ex vivo perfusion can extend the time donor hearts can be perfused, increasing transplantation windows for patients. Currently, donors need to live within four hours of the Peter Munk Cardiac Centre if they’re on the transplant list and can spend months in hospital if their heart function deteriorates dramatically.
He’s also looking forward to studying how to improve the function of donor hearts at a molecular and genetic level to prolong their viability and lengthen the lives of transplant recipients.
“The Peter Munk Cardiac Centre’s mission aligns with what I want to do, which is to improve cardiac transplants in Canada, because some of the most innovative work in cardiac transplants is coming from Toronto.”
Dr. Rabi intends to continue on that path, improving how cardiac surgery is done and how organs are optimized for transplant not just here, but globally.
“UHN has the best environment and the best support, both clinically and research wise, to do just that,” he says.
To read more from this series, click here.
Advertising feature produced by Globe Content Studio with University Health Network’s (UHN’s) Peter Munk Cardiac Centre. The Globe’s editorial department was not involved.