New Technique Could Increase Infant Heart Transplant by 20%
Duke Health performs world’s first on-table heart reanimation for infant transplant
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DURHAM, N.C. – Duke Health has pioneered a world’s-first technique that could expand by up to 20% the donor pool for pediatric heart transplants in the U.S. -- offering new hope to families on the waitlist.
The New England Journal of Medicine is publishing the case study on Wednesday, July 16. It details a groundbreaking approach to overcome barriers to heart donation after circulatory death (DCD) in infants.
“This innovation was born out of necessity,” said Joseph Turek, M.D., Ph.D., senior author of the study and chief of pediatric cardiac surgery at Duke Health. “We were determined to find a way to help the smallest and sickest children who previously had no access to DCD heart donation.”
DCD is a technique which allows for heart donation to take place after a circulatory death, rather than brain death (once the standard in donation), as long as the functionality of the heart can be assessed on a perfusion device. DCD has previously been used in adult and adolescent transplants, but existing perfusion devices are too large to fit infant hearts.
A technique called normothermic regional perfusion (NRP) could reanimate the heart inside of the body, but it carries logistical and ethical barriers – leading many centers to avoid using it. The lack of NRP uptake causes viable pediatric donor hearts to go unused.
To overcome this, the Duke team developed a novel technique that temporarily reanimates the donor heart outside of the body, on a surgical table using a heart-lung machine (extracorporeal membrane oxygenation or ECMO) – allowing surgeons to assess the organ’s viability before transplant. The approach avoids the barriers associated with NRP and could become a new standard of care.
Duke scientists are calling the new technique on-table heart reanimation. The first-of-its-kind case saved the life of a then 3-month-old patient, who received the procedure earlier this year.
Every year in the U.S. about 700 children are added to the waitlist for a pediatric heart transplant, and of those about 10-20% die while waiting on the list, according to the United Network for Organ Sharing.
Turek estimates the new on-table heart reanimation technique has the potential to save as many young lives as there are viable pediatric donor hearts currently going unused.
“This is a major step forward in pediatric transplant medicine,” Turek said. “On-table heart reanimation could dramatically expand the availability of precious donations — transforming loss into life with greater stewardship and hope.”
Duke Health has a history of pioneering research in DCD hearts transplants, performing the nation’s first DCD heart transplant in an adult in 2019 and the first in an adolescent in 2021.
Turek has also led several pioneering pediatric heart transplant techniques, including the partial heart transplant, the living mitral valve replacement, and the thymus-heart co-transplantation for tolerance.
In addition to Turek, other authors include John A. Kucera and Douglas M. Overbey.