Related Experiment Video
Updated: Aug 12, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
First case report of multivisceral transplant from a deceased cardiac death donor
Ane M Andres1, Jose Luis Encinas2, Alba Sánchez-Galán2
1Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (Idipaz), La Paz University Hospital, Madrid, Spain; European Reference Network on Transplantation in Children (TransplantChild ERN), Madrid, Spain; Anatomy, Histology and Neuroscience Department, University Autonoma of Madrid, Madrid, Spain.
Insights
Pediatric multivisceral transplantation from donors after cardiac death is now possible. This innovative approach using normothermic regional perfusion successfully treated a young recipient, potentially reducing waitlist times.
Area of Science:
- Organ transplantation
- Pediatric surgery
- Cardiovascular surgery
Background:
- Pediatric multivisceral transplantation faces donor shortages, leading to prolonged wait times and mortality.
- Donors after cardiac death (DCD) are increasingly used, but intestinal transplantation remains challenging due to ischemia-reperfusion injury.
Observation:
- A 13-month-old recipient received a multivisceral graft from a 2.5-month-old donor after cardiac death.
- Normothermic regional perfusion (NRP) via extracorporeal membrane oxygenation (ECMO) and subsequent beating heart perfusion preserved abdominal organs.
Findings:
- The multivisceral graft, recovered from ischemia through NRP, was successfully transplanted.
- The recipient experienced an uneventful recovery and was discharged two months post-transplant with no complications.
Implications:
- This case demonstrates the feasibility of DCD multivisceral transplantation in pediatric recipients.
- Successful NRP may expand the donor pool and reduce waiting list times for pediatric patients needing complex organ transplants.
Abstract:
The current shortage of pediatric multivisceral donors accounts for the long time and mortality on the waiting list of pediatric patients. The use of donors after cardiac death, especially after the outbreak of normothermic regional perfusion, has increased in recent years for all solid organs except the intestine, mainly because of its higher susceptibility to ischemia-reperfusion injury. We present the first literature case of multivisceral donors after cardiac death transplantation in a 13-month-old recipient from a 2.5-month-old donor. Once exitus was certified, an extracorporeal membrane oxygenation circuit was established, cannulating the aorta and infrarenal vena cava, while the supra-aortic branches were clamped. The abdominal organs completely recovered from ischemia through normothermic regional perfusion (extracorporeal membrane oxygenation initially and beating heart later). After perfusion with the preservation solution, the multivisceral graft was uneventfully implanted. Two months later, the patient was discharged without any complications. This case demonstrates the possibility of reducing the time spent on the waiting list for these patients.
