A new beginning: current trends in pediatric heart transplantation

Recent experience with heart transplantation in the newborn infant as a surgical option for the treatment of HLHS and other fatal heart abnormalities has encouraged the outgrowth of infant heart transplant programs throughout the world. Current trends include noninvasive evaluation of rejection, minimizing immunosuppressive therapy in this age group, and evaluating societal issues such as the cost of transplantation and parental compliance as an indicator of outcome. Implications for nursing practice involve the support of infants and their families during the evaluation process, thus allowing families to receive appropriate counseling regarding their options. This support may include the obstetric nurse in a small hospital or the nurse practitioner in the neonatal intensive care unit. Heart transplant coordinators facilitate the rapid transfer of information from the transplant center to the referring facility regarding management principles that are necessary to support an infant dying of HLHS. Nursing implications in the psychosocial arena include assessing family compliance in an effort to determine its impact on a successful surgical outcome. After transplantation, nursing practice is challenged by participating in the determination of rejection, and contributing to long-term follow-up care.