For the first time, a heart transplant has been successfully performed after transport of a donor heart across the Atlantic Ocean, marking a substantial advancement in the realm of organ transplantation.

The heart transplant took place at the Pitié-Salpêtrière Hospital, Sorbonne University, in Paris, France, in January, 2024. The donor, located in the French West Indies, was a man aged 48 years, declared brain dead 3 days after an intracerebral haemorrhage. Echocardiography and coronary angiography were unremarkable. The donor heart was procured according to routine procedures and 16 min after aortic cross, ex-vivo hypothermic, oxygenated perfusion of the heart was started (XVIVO Heart Assist Transport). The heart was transported to Paris in the cabin on a commercial airline flight. Preservation (12 h 6 min) and perfusion (10 h 32 min) was uneventful, despite severe turbulence.

The recipient, a man aged 70 years, with terminal ischaemic cardiomyopathy and chronic renal insufficiency (estimated glomerular filtration rate [eGFR] 24 mL/min per 1·73 m²) was consented and registered on the PEGASE trial waiting list (NCT06035991). After transplantation (cross-clamp time 82 min, cardiopulmonary bypass time 146 min), the heart immediately had normal biventricular function without any graft dysfunction. The cardiac index was 3·4 L/min per m² with only a low dose of inotropic support. The patient was extubated 10 h after the surgery, had 2 days of continuous renal replacement therapy, and was weaned off inotropic support on day 5. At hospital discharge, 30 days after surgery, eGFR was 30 mL/min per 1·73 m².

This transplant marks the first instance of a donated heart being flown across the Atlantic, covering a distance of 6750 km from the French West Indies to Paris, a feat previously unimaginable in organ transplantation. The success achieved in this instance, in which distance and transport time are no longer limiting factors, has the potential to redefine the landscape of heart transplantation with unlimited geographical procurement and lowered time constraints.