Design And Implementation Of A Multi-pronged Pediatric DCD Heart Procurement Program: No Child Left Behind
Nicholas D. Andersen1, Michael Carboni1, Konrad Rajab2, Douglas Overbey1, Benjamin Bryner1, Desiree Bonadonna1, Sarah Casalinova1, Jacob Schroder1, Joseph W. Turek1.
1Duke University Medical Center, Durham, NC, USA, 2The Medical University of South Carolina, Charleston, SC, USA.
Objective(s): Heart transplantation using donation after circulatory death (DCD) has been accelerating in adults using direct procurement and perfusion (DPP) as well as normothermic regional perfusion (NRP). However, less progress has been made in children. We designed a flexible pediatric DCD heart transplantation program to allow recovery of pediatric hearts of any size.
Methods: For donors weighing >40 kg, DCD procurement is done via DPP with the Transmedics Organ Care System (OCS) Heart device. For donors weighing <40 kg (below the limit for OCS), our protocol uses NRP and cold static storage. For partial heart transplantation (in which only the outflow tracts are transplanted and not myocardium) DCD procurement is done using direct procurement without machine perfusion and cold static storage. We worked to educate organ procurement organizations on the importance of approaching more families for pediatric DCD donation.
Results: Thus far, two pediatric DCD heart procurements have been performed. The first heart was recovered from a 50kg adult donor using DPP and transplanted into a 14-year-old recipient. The second heart was recovered from a 3.0 kg neonate using direct procurement with cold static storage, and was used for transplantation of the aortic and pulmonary roots only. Seven pediatric patients are currently listed for DCD heart transplantation, ranging in age from 4 weeks to 17 years.
Conclusions: A multi-pronged strategy of pediatric DCD heart transplantation based on donor size and recipient need can greatly benefit children on the wait list at our center and others with further refinement and adoption.
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