Innovative Technique May Boost Infant Heart Transplants by 20%

Duke Health has developed a groundbreaking method that has the potential to increase the number of pediatric heart transplants in the United States by up to 20%. This new approach offers new hope to families awaiting life-saving transplants for their children.

The technique, detailed in the recent publication of the New England Journal of Medicine, addresses a significant challenge in pediatric heart transplantation: the underutilization of available donor hearts due to logistical and ethical barriers associated with existing donor procedures. Historically, donation after circulatory death (DCD) has been used for adult and adolescent transplants, but the larger size of perfusion devices made it difficult to apply to infants.

The innovative solution involves a procedure called "on-table heart reanimation." This process entails temporarily restoring the function of the donor heart outside of the body using a heart-lung machine, known as extracorporeal membrane oxygenation (ECMO). This allows surgeons to assess the heart's viability before transplantation, bypassing the limitations of previous methods like normothermic regional perfusion (NRP), which faced logistical and ethical hurdles.

The first successful case applying this technique saved the life of a 3-month-old patient earlier this year. The procedure’s success demonstrates its promise to expand the donor pool significantly, potentially saving many young lives annually. Each year, about 700 children in the U.S. are added to the transplant waitlist, with approximately 10-20% dying before receiving a transplant due to limited donor availability.

Joseph Turek, M.D., Ph.D., senior author of the study and chief of pediatric cardiac surgery at Duke, emphasized the importance of this advancement: "On-table heart reanimation could dramatically increase the availability of donor hearts, transforming the outlook for critically ill pediatric patients."

Duke University has a history of pioneering work in DCD heart transplantation, including the nation’s first DCD heart transplant in an adult in 2019 and the first pediatric transplant in 2021. Turek has also contributed to other innovative pediatric transplant techniques, further establishing Duke’s leadership in this field.

This new approach could mark a significant step forward in pediatric transplant medicine, converting organs that would have otherwise gone unused into opportunities to save young lives.

Source: https://medicalxpress.com/news/2025-07-technique-infant-heart-transplants.html