Pioneering Technique to Increase Infant Heart Transplant by 20%

Each year in the U.S., around 700 children are added to the pediatric heart transplant waitlist, and approximately 10–20% of them die while waiting for a suitable donor organ. A key challenge is the limited availability of viable donor hearts for infants, particularly from circulatory death (DCD) donors. While DCD is a technique that enables organ donation after circulatory rather than brain death, it has been underused in infants due to limitations in existing technologies. Normothermic regional perfusion (NRP) can reanimate the heart within the body, but it poses logistical and ethical challenges that lead many centers to avoid its use. Additionally, existing perfusion devices are too large for infant hearts, causing many potentially viable donor organs to go unused. Now, a groundbreaking approach that enables external reanimation and evaluation of infant donor hearts could potentially expand the pediatric donor pool by up to 20%.

The pioneering technique called on-table heart reanimation that was developed and successfully applied by researchers at Duke Health (Durham, NC, USA) overcomes the limitations of traditional DCD heart recovery in infants. Instead of using NRP or oversized perfusion devices, the team reanimated the donor heart outside the body on a surgical table using a heart-lung machine, known as extracorporeal membrane oxygenation (ECMO). This setup allowed surgeons to evaluate the heart's viability before transplantation while avoiding the complications associated with NRP. The innovation was driven by the urgent need to provide life-saving options for the smallest and sickest patients who previously had no access to DCD heart donations.

The technique was successfully used earlier this year to save the life of a 3-month-old patient, marking the first use of on-table heart reanimation in the world. The case study, published in The New England Journal of Medicine, highlights the potential for this approach to become a new standard of care in pediatric heart transplantation. With the ability to reanimate and assess infant hearts externally, the method could dramatically increase the number of usable donor organs and offer renewed hope to families awaiting transplants. Researchers plan to continue refining and promoting the technique, aiming to transform loss into life through greater stewardship and innovation in transplant medicine.

"This is a major step forward in pediatric transplant medicine. On-table heart reanimation could dramatically expand the availability of precious donations — transforming loss into life with greater stewardship and hope," said Joseph Turek, MD, PhD, chief of pediatric cardiac surgery at Duke Health and senior author of the study.

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