Related Experiment Video
Updated: Jan 15, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
HOPE for children: successful pediatric DCD heart transplantation using hypothermic oxygenated perfusion
Nicholas Js Chilvers1, Katrien Vandendriessche2, Niels Moeslund3
1Paediatric Heart Unit, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
Insights
Hypothermic oxygenated perfusion (HOPE) enables successful pediatric donation after circulatory death (DCD) heart transplants, even for neonates. This technique offers a vital solution to improve heart transplant equity for children.
Area of Science:
- Pediatric cardiology and cardiothoracic surgery
- Organ transplantation and preservation
- Bioengineering and medical device development
Background:
- Increasing demand for pediatric heart transplants due to rising advanced heart failure cases.
- Declining transplantation rates and high waiting list mortality (up to 25%) in pediatric patients.
- Barriers to utilizing donation after circulatory death (DCD) for pediatric heart recovery, unlike in adults.
Purpose of the Study:
- To evaluate the feasibility and efficacy of hypothermic oxygenated perfusion (HOPE) for pediatric DCD heart recovery and transplantation.
- To address the inequity in pediatric heart transplantation by enabling DCD donation.
- To demonstrate the potential of HOPE for even neonatal donors.
Main Methods:
- Development of a preclinical porcine DCD-HOPE model simulating neonatal and infant heart recovery.
- Clinical application of DCD-HOPE in 6 pediatric donors (aged 16 months-13 years).
- Utilized pediatric research cannulas and surgical techniques like arch augmentation for small donors.
Main Results:
- Successful recovery, perfusion, and transplantation of porcine infant hearts in the preclinical model.
- Successful transplantation of pediatric DCD hearts from donors as small as 9 kg.
- Median warm ischemic time of 19 minutes for DCD hearts, with no severe primary graft dysfunction and 100% survival at follow-up.
Conclusions:
- Hypothermic oxygenated perfusion (HOPE) is a viable solution for pediatric DCD heart recovery, including neonatal donors.
- The study reports the world's first and smallest pediatric DCD-HOPE heart transplants.
- Call for support from clinicians and policymakers to implement DCD-HOPE for pediatric transplant equity.
Background:
The number of children referred for advanced heart failure management is increasing and with it the demand for heart transplant. However, transplantation rates have declined and waiting list mortality is up to 25%. While donation after circulatory death (DCD) heart recovery has increased adult transplant activity significantly, barriers have prevented the same in pediatrics. In the UK and Belgium, we have adopted hypothermic oxygenated perfusion (HOPE) to address this inequity.
Methods:
Preclinical: A porcine DCD-HOPE model was developed to simulate neonatal and infant heart recovery, preservation, and transplantation, including functional assessment.
Clinical:
Hearts were recovered from 6 pediatric donors (3 DCD and 3 donation after brainstem death), aged 16 months-13 years), preserved with HOPE and transplanted. For small donors, this required a pediatric research cannula and surgical techniques, such as arch augmentation.
Results:
In the preclinical model, porcine infant hearts could be successfully recovered, perfused, and transplanted with good cardiac output postbypass. In the clinical series, hearts from donors as small as 9 kg were successfully recovered, perfused, and transplanted. For the DCD cohort, median functional warm ischemic time was 19 minutes and there was no severe primary graft dysfunction. Survival at follow-up (median 287.5 days) was 100% and echocardiograms showed normal systolic function.
Conclusions:
There is great need to facilitate DCD heart recovery for infants and neonates. We have reported our outcomes from the world's first and smallest pediatric DCD-HOPE heart transplants and demonstrated that HOPE provides the long-awaited solution for pediatric DCD donation down to even neonatal donors. We call upon clinicians and policymakers to support DCD-HOPE to provide equity for child donors and recipients.
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