Related Experiment Video
Updated: Jun 23, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Pediatric heart transplantation after declaration of cardiocirculatory death
Mark M Boucek1, Christine Mashburn, Susan M Dunn
1Department of Pediatrics, Joe DiMaggio Children's Hospital, Hollywood, FL 33021, USA. mboucek@mhs.net
Insights
Infants undergoing heart transplants using organs from donors who died from cardiocirculatory causes showed excellent survival and outcomes. This approach may reduce critical waiting list mortality in pediatric cardiac transplantation.
Area of Science:
- Cardiology
- Transplantation immunology
- Pediatric surgery
Background:
- Infant heart transplantation is critical due to high waiting list mortality.
- Standard organ donation protocols may not adequately address the pediatric donor pool.
- Cardiocirculatory death donors present a potential resource for infant cardiac transplantation.
Purpose of the Study:
- To evaluate the feasibility and outcomes of using organs from cardiocirculatory death donors for infant orthotopic cardiac transplantation.
- To compare survival and immunological outcomes with standard organ donation in infants.
Main Methods:
- Retrospective analysis of three infants receiving heart transplants from cardiocirculatory death donors.
- Comparison with a control group of 17 infants receiving standard donor organs.
- Assessment of 6-month and long-term survival, rejection episodes, and echocardiographic function.
Main Results:
- Successful transplantation in all three high-risk infants.
- 100% 6-month survival compared to 84% in controls.
- Similar low rates of rejection episodes and comparable echocardiographic function at 6 months.
- No late deaths or significant immunological differences observed up to 3.5 years.
Conclusions:
- Organs from cardiocirculatory death donors are viable for infant orthotopic cardiac transplantation.
- This strategy offers a promising avenue to decrease mortality in infants awaiting heart transplants.
- Outcomes are comparable to standard donor organs, suggesting safety and efficacy.
Abstract:
In three infants awaiting orthotopic cardiac transplantation, transplantation was successfully performed with the use of organs from donors who had died from cardiocirculatory causes. The three recipients had blood group O and were in the highest-risk waiting-list category. The mean age of donors was 3.7 days, and the mean time to death after withdrawal from life support was 18.3 minutes. The 6-month survival rate was 100% for the 3 transplant recipients and 84% for 17 control infants who received transplants procured through standard organ donation. The mean number of rejection episodes among the three infants during the first 6 months after surgery was 0.3 per patient, as compared with 0.4 per patient among the controls. Echocardiographic measures of ventricular size and function at 6 months were similar among the three infants and the controls (left ventricular shortening fraction, 43.6% and 44.9%, respectively; P=0.73). No late deaths (within 3.5 years) have occurred in the three infants, and they have had functional and immunologic outcomes similar to those of controls. Mortality while awaiting a transplant is an order of magnitude higher in infants than in adults, and donors who died from cardiocirculatory causes offer an opportunity to decrease this waiting-list mortality.
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