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 United States to undergo a DCD transplant using organ preservation technology developed by Transmedics. A small number of children received the first versions of the DCD transplant – which uses organs taken from donors with no cardio-respiratory function – from the 1980s, but the method had limitations.
Organ preservation technology, which maintains the pumping action of the heart, received FDA approval this week for heart donation in adults after brain death. For their 14-year-old patient, Duke’s surgeons have received special compassionate use authorization from the FDA to use the technology for the DCD transplant.
“This is a historic achievement for children with end-stage heart failure,” said Joseph Turek, MD, Ph.D., chief of pediatric cardiac surgery at Duke who, along with Benjamin Bryner, MD, has recovered the donated organs. Nick Andersen, MD, and Jacob Schroder, MD, led the eight-hour surgery, which also included a team of four nurses.
Children are, unfortunately, an underserved population when it comes to innovation, technology adaptation and clinical trials. It is our duty to defend them and to continue to advance care in pediatric medicine. “
Joseph Turek, MD, Ph.D., chief of pediatric cardiac surgery at Duke
Duke has been a leader in DCD transplantation. In 2019, Duke surgeons performed the first adult DCD heart transplant in the United States and led the country in DCD heart transplants in a clinical trial that helped the company’s request for approval. with the FDA.
“This case shows how well Duke is suited to pioneering innovations in pediatric heart transplantation, thanks to our close collaboration and teamwork with the renowned adult heart transplant team,” said Andersen.
Although DCD technology cannot yet be used for the little ones, it could potentially be suitable for the older ones. In Duke alone, the method could be indicated for up to five children per year. This option could significantly reduce the time children spend waiting for a donor heart.
“It’s heartbreaking that children are dying while waiting for a heart transplant, and every progress that makes more hearts available saves lives,” said Schroder, director of Duke’s heart transplant program. “We look forward to exploring all of the options that give hope to children and their families.”
The pediatric patient, Jaynzra “Nae” Rice, is a 14-year-old girl who was born with genetic deletion syndrome and cannot verbally communicate what she is experiencing. Hospitalized at Duke earlier this year with difficulty breathing, she received an LVAD – a left ventricular assist device that helps the heart pump – and spent three months in the hospital.
Nae’s mother, Brandaline Rice, said she worried she was not sure what was coming next for her daughter. But about three months after discharge from the hospital, the family learned that Nae was eligible for the first pediatric DCD heart transplant.
Since the August 31 procedure, Nae continues to improve. While the teenager still has a long way to go with rehabilitation, her mother is confident in her fighting spirit. The family eagerly awaits Nae to take the bus back to school and spend time with her 10-year-old sister.
“God grant a second chance,” Brandaline said of her daughter’s journey to become the first child to receive this type of procedure.