Related Experiment Video
Updated: Jul 25, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Donor supply for partial heart transplantation in the United States
Ritchelli Quintao1, Jennie H Kwon1, Katherine Bishara1
1Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Insights
Partial heart transplantation offers a viable solution for children with congenital heart valve disease. A significant supply of recoverable valves from pediatric donors exists, making this procedure feasible for various age groups.
Area of Science:
- Pediatric Cardiology
- Transplantation Immunology
- Biomaterials Science
Background:
- Congenital heart disease (CHD) is a leading cause of birth defects globally, with valvular defects being a common manifestation.
- Current treatments for pediatric unrepairable valve disease are limited, leading to high mortality and reoperation rates due to issues with prostheses like anticoagulation and lack of growth.
- Partial heart transplantation using fresh valve allografts presents a durable, non-thrombogenic alternative with growth potential for pediatric patients.
Purpose of the Study:
- To assess the potential donor supply for partial heart transplantation in pediatric patients.
- To determine the availability of viable valves from pediatric donor hearts not utilized for full transplantation.
- To evaluate the feasibility of partial heart transplantation as a treatment for pediatric valvular heart disease.
Main Methods:
- Analysis of the United Network for Organ Sharing (UNOS) database from January 2010 to September 2021.
- Identification of pediatric donor hearts with viable valves that were not recovered.
- Categorization of recoverable valves by donor age groups: infants (<1 year), toddlers (≥1 to <3 years), and children (≥3 to <18 years).
Main Results:
- Over 3,500 pediatric donor hearts with recoverable valves were identified in the UNOS database during the study period.
- An average of 29 infant, 39 toddler, and 230 child valves were available annually.
- Recoverable valves were found across all pediatric age groups, indicating a consistent potential supply.
Conclusions:
- The study identifies a substantial minimum donor supply for partial heart transplantation in pediatric patients.
- Partial heart transplantation is logistically feasible, with available valves for all pediatric age groups.
- This approach addresses a critical clinical need for durable and growing valve replacement options in children with unrepairable valve disease.
Background:
Congenital heart disease (CHD) is the most common cause of birth defects worldwide. Valvular defects are a common form of CHDs, and, at this time, treatment options for children with unrepairable valve disease are limited. Issues with anticoagulation, sizing, and lack of growth in valve replacement options can lead to high mortality rates and incidence of reoperations. Partial heart transplantation, or transplantation of fresh valve allografts, has recently been described as a strategy to provide a durable and non-thrombogenic alternative to conventional prostheses and provide growth potential in pediatric patients.
Methods:
The United Network for Organ Sharing (UNOS) database was queried to analyze the number of pediatric donor hearts that were not recovered but had viable valves (n = 3565) between January 2010 and September 2021. Recoverable valves were grouped by donor age: infants (age < 1 year), toddlers (age ≥1 and <3 years), and children (age ≥3 and <18 years). Demographic characteristics of donors were analyzed between age groups.
Results:
Infants, toddlers, and children had a total of 344, 465, and 2756 hearts with recoverable valves, respectively, over the study period, representing an average of 29, 39, and 230 hearts with recoverable valves per year.
Conclusion:
The results of our study identify the minimum donor supply for partial heart transplantation. The actual number is likely higher because it includes hearts not entered in the UNOS database and domino transplants from orthotopic heart transplant recipients. Partial heart transplantation is logistically feasible as there are recoverable valves available for all age groups, fulfilling a clinical need in pediatric patients with unrepairable valve disease.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...