Partial heart transplantation in resource-limited settings: challenges and feasibility

Partial heart transplantation provides living, growth-capable valve implants for paediatric recipients. The feasibility and challenges of implementing partial heart transplantation in resource-limited settings are evaluated, where the burden of valvular heart disease is greatest and paediatric valve replacement options remain severely limited.

A comprehensive search was conducted examining partial heart transplantation clinical outcomes, organ procurement logistics, immunosuppression requirements, and the infrastructure landscape for cardiac surgery in low-and middle-income countries. A feasibility framework was developed by mapping partial heart transplantation-specific requirements against existing low-and middle-income country cardiac surgical capacity.

Compared to orthotopic heart transplantation, several features of partial heart transplantation are inherently favourable for low-and middle-income country adaptation: it allows for longer graft ischaemia times, requires only tacrolimus monotherapy, and can source valves from hearts unsuitable for orthotopic heart transplantation. However, significant barriers persist, including limited organ procurement infrastructure, absence of regulatory frameworks for equitable donor-recipient matching, restricted access to therapeutic drug monitoring, and high rates of loss to follow-up.

Implementation of partial heart transplantation in resource-limited settings is feasible at established middle-income country cardiac surgery centres with transplant capability. A phased strategy leveraging international partnerships, existing infrastructure, and generic immunosuppression offers a realistic pathway to bringing this innovation to the children who need it most.