Duke Health has developed a new technique that could potentially increase the donor pool for pediatric heart transplants in the United States by up to 20%. The New England Journal of Medicine is set to publish a case study on this groundbreaking approach, which aims 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.”
Traditionally, heart donations have been limited to those occurring after brain death. However, DCD allows for donations following circulatory death, provided the heart’s functionality can be assessed using a perfusion device. While this method has been used in adult and adolescent transplants, existing devices are too large for infant hearts.
The Duke team addressed this issue by developing a novel technique that temporarily reanimates the donor heart outside of the body on a surgical table using extracorporeal membrane oxygenation (ECMO). This allows surgeons to assess the organ’s viability before transplanting it. This approach avoids the logistical and ethical barriers associated with normothermic regional perfusion (NRP), which many centers avoid due to its complexity.
Named on-table heart reanimation, this technique saved the life of a 3-month-old patient earlier this year. According to Turek, “This is a major step forward in pediatric transplant medicine.”
Every year around 700 children are added to the waitlist for pediatric heart transplants in the U.S., with 10-20% dying while waiting. The new technique offers hope for increasing available donor hearts.
Duke Health has been at the forefront of research in DCD heart transplants, having performed pioneering procedures in adults and adolescents since 2019. Turek himself has led several innovative techniques in pediatric transplants.
In addition to Turek, other contributors include John A. Kucera and Douglas M. Overbey.
