Pediatric heart transplantation after declaration of cardiocirculatory death

N Engl J Med. 2008 Aug 14;359(7):709-14. doi: 10.1056/NEJMoa0800660.


In three infants awaiting orthotopic cardiac transplantation, transplantation was successfully performed with the use of organs from donors who had died from cardiocirculatory causes. The three recipients had blood group O and were in the highest-risk waiting-list category. The mean age of donors was 3.7 days, and the mean time to death after withdrawal from life support was 18.3 minutes. The 6-month survival rate was 100% for the 3 transplant recipients and 84% for 17 control infants who received transplants procured through standard organ donation. The mean number of rejection episodes among the three infants during the first 6 months after surgery was 0.3 per patient, as compared with 0.4 per patient among the controls. Echocardiographic measures of ventricular size and function at 6 months were similar among the three infants and the controls (left ventricular shortening fraction, 43.6% and 44.9%, respectively; P=0.73). No late deaths (within 3.5 years) have occurred in the three infants, and they have had functional and immunologic outcomes similar to those of controls. Mortality while awaiting a transplant is an order of magnitude higher in infants than in adults, and donors who died from cardiocirculatory causes offer an opportunity to decrease this waiting-list mortality.

Publication types

  • Controlled Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain Death
  • Death*
  • Follow-Up Studies
  • Graft Rejection / epidemiology
  • Heart Arrest*
  • Heart Defects, Congenital / surgery
  • Heart Transplantation* / methods
  • Heart Transplantation* / mortality
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Prognosis
  • Survival Rate
  • Third-Party Consent
  • Time Factors
  • Tissue Donors*
  • Tissue and Organ Procurement / methods*
  • Treatment Outcome