“It’s hard to believe I am walking around with someone else’s heart in me. I feel good and I am very thankful for the gift of life,” says Tony DiGiorgio, seated outside his Rhode Island home.

Tony DiGiorgio’s heart had been through a lot.

Since he was 37, DiGiorgio has had coronary artery disease, requiring extensive interventions and surgical procedures.

This year, the 68-year-old Rhode Island resident embarked on a hopeful new chapter when he became the Brigham’s first recipient of a donation after circulatory death (DCD) heart transplant.

“Everyone assured me that this was going to be a process that would catch on and expands the area from which they can draw donor hearts,” he said. “It turns out I got the first one here.”

A Game-Changing Technique

According to the Center for Organ Recovery and Education, most current heart transplants occur after brain death. These donors have experienced an irreversible loss of brain function, and the heart is kept beating only through mechanical intervention. Strict criteria must be met to be considered for transplantation.

A DCD heart transplant is a relatively new practice involving donors who do not meet full brain death criteria but have suffered injuries incompatible with life. These criteria, though still stringent, dramatically increase the availability of donor organs.

“Previously, a donor heart may come from as far as Atlanta for patients in Boston,” said Akinobu Ito, MD, PhD, surgical director of Heart Transplantation and Mechanical Circulatory Support, who led the multidisciplinary team that performed DiGiorgio’s transplant. “Now, donation after circulatory death could potentially extend that range to Texas and even to the West Coast. That’s allowing our candidates access to a greater geographic area and greater numbers of donors.”

The first DCD heart transplant in the United Sates was performed in 2019 and has rapidly grown in adoption since then.

A key factor in DCD’s effectiveness is the use of the new technology that can circulate blood through the heart during transportation — allowing for donation across far greater distances.

After sustaining an unrelated infection that eventually traveled to his heart, DiGiorgio was referred to Brigham cardiologist Robert Giugliano, MD, ScM, who diagnosed him with heart failure.

“The whole experience of recovering from that — it was traumatic,” DiGiorgio recalled. “I went through it, and I’m glad that I did because it brought me to the Brigham and led me to where I am today.”

In February 2022, he was placed on the transplant waiting list. After almost a year, a compatible donor heart became available in January 2023, and DiGiorgio consented to being the Brigham’s first DCD heart transplant recipient.

“He was not a candidate for another bypass surgery or stenting that would be more typical of procedures we use to treat patients who have ischemia,” explained Michael Givertz, MD, medical director of Heart Transplantation and Mechanical Circulatory Support, who oversaw DiGiorgio’s treatment. “Because he didn’t have any of those traditional options available, he met the criteria for heart transplantation.”

In addition, most heart transplants are typically performed on people age 65 or younger, but DiGiorgio’s good health aside from his heart condition made him a candidate regardless.

“Mr. DiGiorgio might be 68 chronologically, but physiologically might still be considered in his late 50s,” Givertz said. “He’s someone who exercises regularly, takes good care of himself and doesn’t have other chronic medical conditions.”

A First in Brigham’s History

On Jan. 29, DiGiorgio’s transplant was successfully conducted by a surgical team led by Itoh that also included cardiothoracic surgeons Mohamed Keshk, MD, and Mark Cunningham, MD.

DiGiorgio and his wife, Janet, enjoy a recent outing together.

“The organization of the transplant, the timing and coordination of the donor, and the implant operation took over 24 hours to complete,” Itoh said. “This was a truly multidisciplinary effort and would not be possible without support from our colleagues in cardiac anesthesia, cardiac intensive care and cardiology.”

After DiGiorgio experienced some complications while recovering from surgery, his multidisciplinary team on Shapiro 6 administered lifesaving treatments and monitored him closely overnight. By the next day, his heart was functioning at a normal level.

“I couldn’t have asked for better care from the whole team,” DiGiorgio said. “I have gone through so much in my medical journey, and I have prevailed through so much in the past 30 years. How lucky am I that everything fell into place?”

Givertz and Itoh both noted DiGiorgio’s exceptional recovery and eagerness to get back on his feet.

“He’s doing so well in such a short period of time and he’s anxious to get started in cardiac rehab,” Givertz said. “In fact, I was ready to make a referral, and the nurses had to remind me that we don’t refer patients to cardiac rehab until three months after their heart transplant.”

DiGiorgio said he can’t wait to get back to living his life with full enjoyment. He currently is the head golf professional at a country club in Rhode Island, where he manages operations, tournaments and teaching. He hopes to go back to playing his favorite sport soon with his wife, Janet, once he’s physically able.

“It’s hard to believe I am walking around with someone else’s heart in me. I feel good and I am very thankful for the gift of life,” DiGiorgio said. “I’m going to retire at the end of the year, and hopefully we’ll have a few years of traveling in the future for us both. We’ve been through a lot. We — and this heart — deserve to live our lives.”