A new heart transplant method will increase the chances of the youngest patients

A novel technique developed at Duke Health could increase the availability of infant heart transplants by up to 20%, providing hope to children previously ineligible for transplantation. The procedure, just described in the New England Journal of Medicine, allows for the evaluation of a donor heart after cardiac arrest through extracorporeal resuscitation. The first successful transplant saved the life of a three-month-old baby.

About 700 children a year in the United States are placed on the heart transplant waiting list, and 10–20% of them die before a suitable donor is found. Now, a team at Duke Health has developed a technique that could increase the number of hearts available for infants by up to 20%. The study's authors say this could be a real breakthrough.

Until now, donor hearts from deceased cardiac arrest (DCD) have not been used in pediatric patients because the equipment required for resuscitation and organ evaluation was too large for the smallest patients. Although effective, the NRP (normothermic regional perfusion) technique remains controversial due to its ethical and logistical implications.

The Duke team set out to change that. They developed a new method that allows for heart resuscitation outside the body, without the need for NRP. "This innovation was born out of necessity," says Dr. Joseph Turek, chief of pediatric cardiac surgery at Duke Health and lead author of the study. "We were determined to find a way to help the youngest and sickest children who previously had no access to heart transplants through the Duke Health program."

The new technique involves briefly resuscitating the donor heart outside the body using an ECMO (heart-lung machine), allowing the viability of the organ to be assessed before transplantation. The team has dubbed the procedure "cardiac resuscitation on the operating table."

The first procedure of this type was performed on a three-month-old baby and was successful. This proves that the method works and can be implemented more widely. Turek emphasizes: "This is a huge step forward in pediatric transplant medicine."

Duke Health has been pioneering DCD transplantation for years – in 2019, it performed the first heart transplant in the US in an adult with DCD, and in 2021, the first in an adolescent. Now it's time for infants.

The team hopes that thanks to this new approach, more families will have a chance at life for their child.