Surgeons at Duke University Hospital have successfully performed a “donation after circulatory death” (DCD) heart transplant in a pediatric patient, demonstrating the potential expansion of eligible donor hearts for children with heart failure.
The transplant took place on August 31 and is the first pediatric patient in the US to undergo a DCD transplant using the organ preservation technology developed by Transmedics. A small number of children received early versions of DCD transplantation — which uses organs retrieved from donors with no cardio-respiratory function — beginning in the 1980s, but the method had limitations.
The organ preservation technology, which maintains the heart’s pumping action, received FDA approval this week for heart donations in adults after brain death. For their 14-year-old patient, Duke surgeons received special compassionate use approval from the FDA to use the technology for the DCD transplant.
“This is a milestone for children with end-stage heart failure,” says Joseph Turek, MD, Ph.D., chief of pediatric cardiac surgery at Duke, who, along with Benjamin Bryner, MD, collected the donated organs. Nick Andersen, MD, and Jacob Schroder, MD, led the eight-hour operation, which also involved a team of four nurses.
Unfortunately, children are a disadvantaged population when it comes to innovation, technology adaptation and clinical trials. It is our duty to stand up for them and continue to advance care in pediatrics.”
Joseph Turek, MD, Ph.D., chief of pediatric cardiac surgery at Duke
Duke is a leader in DCD transplantation. In 2019, Duke surgeons performed the United States’ first adult DCD heart transplant and led the nation in DCD heart transplants as part of a clinical trial that contributed to the company’s FDA application for approval.
“This case demonstrates how Duke is ideally suited to pioneering innovations in pediatric heart transplantation, thanks to our close collaboration and teamwork with the renowned adult heart transplant team,” Andersen said.
While DCD technology cannot yet be used for the smallest children, it could potentially be adapted to older young people. At Duke alone, the method could be indicated for as many as five children per year. Having this option can significantly reduce the amount of time children spend waiting for a donor heart.
“It’s heartbreaking that children die waiting for a heart transplant, and any advancement that makes more hearts available is one that saves lives,” said Schroder, director of Duke’s heart transplant program. “We are eager to explore all the options that give children and their families hope.”
The pediatric patient, Jaynzra “Nae” Rice, is a 14-year-old who was born with gene deletion syndrome and cannot verbally communicate what she is experiencing. She was hospitalized in Duke earlier this year with breathing difficulties, received an LVAD — a left ventricular device that helps the heart pump — and spent three months in the hospital.
Nae’s mother, Brandaline Rice, said she was afraid of not knowing what was coming for her daughter. But about three months after being discharged from the hospital, the family was told that Nae was a candidate for the first DCD heart transplant in children.
Since the August 31 procedure, Nae continues to improve. Although the teen still has a long journey ahead of him in rehab, her mother is confident in her fighting spirit. The family is looking forward to seeing Nae back to school by bus and enjoying time with her 10-year-old sister.
“God gives second chances,” Brandaline said of her daughter’s journey to become the first child to have such a procedure.