New Heart Recovery Approach May Broaden Pediatric Transplant Donor Pool

Pediatric heart transplantation is constrained by the limited availability of suitable donor hearts. Children can wait many months for transplant, particularly neonates and infants. Long waiting times are associated with about 20% mortality among children on the waiting list, which includes more than 2,000 children each year. New findings demonstrate that a heart recovery method adapted for pediatric transplantation may expand access to donor organs.

Vanderbilt Health (Nashville, TN, USA), with pediatric heart transplant surgeons at Monroe Carell Jr. Children's Hospital at Vanderbilt, has adapted rapid recovery with extended ultraoxygenated preservation (REUP) for children. The technique was originally developed by Vanderbilt Health’s adult heart transplant team for hearts donated after circulatory death. It is intended to preserve donor hearts without reanimating them before transplantation.

REUP preserves the heart by flushing it with a cold, oxygen-rich solution after death. Existing approaches for donation after circulatory death require reanimation of the donor heart either inside the donor’s body or on specialized perfusion devices. The article states that those approaches can raise ethical concerns in some settings and may be expensive, complex, or limited by patient size.

In a New England Journal of Medicine article, surgeons with the Golisano Pediatric Heart Institute at Monroe Carell and Vanderbilt Health’s adult heart transplant team described recovery and transplantation of five donor hearts in children. The children ranged in age from 2 days to 14 years. Since that report, five more children have been treated using the same approach.

The recipients waited an average of 20 days for transplantation. No donor hearts were discarded, and all recipients demonstrated strong heart function after surgery. None required mechanical circulatory support after transplantation, experienced primary graft dysfunction, or showed evidence of rejection during the study period.

All donor recoveries in the pediatric study occurred in settings where donor heart reanimation was not permitted because of ethical concerns. The investigators noted that without REUP, these hearts would not have been available for transplantation. The article also states that the pediatric program’s early success builds on previous Vanderbilt Health findings demonstrating REUP effectiveness in adults.

“This innovative approach is truly transformative for the field of pediatric heart transplantation. Having the ability to expand the organ donor pool and utilize hearts that would otherwise be discarded is a true blessing for our patients. We are planning on helping other programs advance and adopt this technique to hopefully allow saving many more lives,” said Ziv Beckerman, M.D., associate chief of pediatric cardiac surgery, surgical director of pediatric heart transplantation in the Golisano Pediatric Heart Institute at Monroe Carell and senior author of the NEJM article.

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Vanderbilt Health
Monroe Carell Jr. Children's Hospital