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Ex situ heart perfusion for optimization of pediatric donor organ utilization: Attitudes and perceptions
Madeleine Townsend1, Tara Pidborochynski2, Michael van Manen3
1Division of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada.
Insights
Ex situ heart perfusion (ESHP) shows promise for reducing waitlist mortality in pediatric heart transplant patients. Further education on ESHP outcomes and risks is needed for wider adoption of this technology.
Area of Science:
- Pediatric Cardiology
- Transplant Surgery
- Medical Device Technology
Background:
- Pediatric heart failure patients face high mortality rates while awaiting transplantation.
- Ex situ heart perfusion (ESHP) is a technique to preserve donor hearts, potentially increasing transplant accessibility.
- A pediatric ESHP device is currently unavailable, necessitating evaluation of its potential use.
Purpose of the Study:
- To assess pediatric heart transplant practitioners' current knowledge of ESHP.
- To identify potential barriers to ESHP implementation in pediatric care.
- To explore prospective applications of ESHP in pediatric heart transplantation.
Main Methods:
- An electronic survey was distributed to 68 international pediatric heart transplant stakeholders.
- Survey responses were analyzed to understand perspectives on ESHP.
- Statistical analysis explored associations between respondent characteristics and ESHP familiarity.
Main Results:
- Most practitioners were familiar with ESHP, but fewer than 10% had clinical experience.
- There is optimism that ESHP can reduce waitlist mortality.
- Concerns include device malfunction and a lack of long-term outcome data.
- Familiarity with ESHP did not differ by age, center volume, country, or discipline.
Conclusions:
- ESHP holds potential to increase the pediatric heart donor pool and decrease waitlist mortality.
- Enhanced education regarding ESHP outcomes, risks, and benefits is crucial for widespread adoption.
- Further research and development of pediatric-specific ESHP devices are warranted.
Background:
Children with heart failure have the highest mortality while awaiting transplantation. Ex situ heart perfusion (ESHP), a method for continuous perfusion of the donor heart, has the potential to improve access to transplant by increasing travel distance between donor and recipient. An adult ESHP device is currently available, but as of yet there is no pediatric device. The aim of this study was to evaluate current knowledge of ESHP among pediatric heart transplant practitioners, define potential barriers, and identify uses of this novel technology.
Methods:
An electronic survey was developed to assess perspectives of international pediatric heart transplant stakeholders (n = 68) on ESHP. Select questions were analyzed to evaluate for associations between groups of respondents and patterns of response.
Results:
Most respondents were familiar but <10% had clinically utilized ESHP. There was optimism that ESHP could decrease waitlist mortality. Respondents were concerned about potential device malfunction and lack of long-term outcomes. There were no differences found in terms of ESHP familiarity among age groups, practitioner center volume, country of work, or discipline.
Conclusions:
ESHP has the potential to expand the pediatric heart donor pool and decrease waitlist mortality. More education on outcomes and risks/benefits is needed in order to promote widespread adoption.
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