Intentional and successful use of a marginal donor heart with surgically-corrected interventricular communication

We describe a case of heart transplantation (HTX) performed using a heart from a 20-year-old donor who underwent surgical closure of a ventricular septal defect during childhood. Our 26-year-old patient was successfully discharged to a rehabilitation centre on day 20 post-transplantation. To our knowledge, this is the first report of an HTX performed with a 'redo' donor heart with previous surgical correction of a congenital heart defect. The widespread use of HTX as a therapeutic option is currently limited by the increase in number of patients listed annually for this procedure. The concomitant lack of organ donors has led to the concept of 'marginal donor' to broaden the classic standard criteria of donor suitability, but these extended criteria do not consider the possibility of using hearts that have undergone surgical correction of simple congenital heart defects. There has been a considerable increase in the grown-up congenital heart disease population over the past 20 years. We discuss the feasibility of using these hearts for transplantation and consider the limitations and precautions of such practice.