Availability and selection of donors for pediatric heart transplantation

Applying generally accepted criteria for selection of adult heart donors, we conducted a retrospective study of brain-dead infants and children for assessment of suitability as donors for heart transplantation. Cardiac histopathologic studies were evaluated in all subjects undergoing autopsy.

In 5 years there were 58 such patients, the majority of whom had head injury, near-drowning, near-miss sudden infant death syndrome, infection, or asphyxia. Of these, only five met the proposed clinical criteria. Most prospective donors were eliminated on the basis of prolonged cardiac arrest (n = 33), pressor dependency (n = 25), and/or infection (n = 10). Forty-two subjects underwent autopsy, of whom 36 would not have been excluded as donors except on the basis of ischemic cardiac insult. Of these, 18 subjects were found to have essentially normal myocardium, nine had abnormal but potentially reversible microscopic changes, and nine had myocardial infarction. The pathologic findings were not predicted by the selection criteria, but severe chest trauma was not associated with infarction, eight of the nine patients with infarction had had cardiac arrest, and most of those with infarction had drowned or had had sudden infant death syndrome.

The supply of donor organs for pediatric heart transplantation is very limited if selection criteria used for adult donors are applied. These criteria, however, do not correlate well with myocardial pathologic findings in infants and children. More accurate predictors of donor suitability are needed.