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Related Experiment Video

Updated: May 11, 2026

Pre-clinical Model of Cardiac Donation after Circulatory Death

Pre-clinical Model of Cardiac Donation after Circulatory Death

Published on: August 2, 2019

A comprehensive, multifaceted strategy to increase pediatric donor heart utilization.

Seth A Hollander¹, Sharon Chen¹, John Dykes¹

¹Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation

|June 30, 2024

Summary

Quality improvement initiatives successfully increased pediatric heart offer acceptance and transplant volume. Utilizing extended criteria donor hearts did not negatively impact patient survival, demonstrating a safe and effective strategy.

Keywords:

allocation donor heart pediatric waitlist

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Area of Science:

Cardiology
Transplant Surgery
Quality Improvement Science

Background:

Initiated a quality improvement program in 2016 to enhance pediatric heart offer acceptance.
Assessed the impact of implemented interventions on donor heart utilization and transplant outcomes.

Purpose of the Study:

To evaluate the effectiveness of a multifaceted quality improvement strategy aimed at increasing pediatric donor heart acceptance and utilization.
To determine the impact of utilizing "extended criteria" donor hearts on post-transplant outcomes.

Main Methods:

Compared pre- (2008-2016) and post-implementation (2017-2023) cohorts of pediatric heart transplant recipients.
Implemented six interventions: ABO-incompatible transplants, ex vivo perfusion, 3D total cardiac volume (TCV) assessment, acceptance of hepatitis-C/SARS-CoV-2 infected donors, and cultural shifts.
Analyzed changes in annual heart transplant (HT) volume, waitlist duration, acceptance sequence, and post-transplant outcomes.

Main Results:

Annual HT volume increased from 16 to 25 post-intervention.
Waitlist duration decreased significantly (p=0.01), and the use of extended criteria hearts increased (p<0.001).
Institutional culture change and TCV assessment most significantly improved donor heart utilization (p=0.04 and p<0.001, respectively); post-transplant survival was unaffected (p=0.3).

Conclusions:

A longitudinal, multifaceted quality improvement effort successfully increased organ offer utilization.
Institutional culture change and TCV assessments were key drivers of improved donor heart utilization.
The use of extended criteria donor hearts is a safe strategy, not associated with inferior post-transplant survival.