Infant Heart Transplant Controversy Continues

WEDNESDAY, Aug. 13 (HealthDay News) -- Three new reports challenge current guidelines on how long after cardiac death doctors must wait before taking a heart from an infant organ donor.

There's no question that organ donation saves lives, and there's also no question that there aren't enough donor organs to save everyone on the transplant list. However, deciding who is a suitable organ donor, particularly when the potential donor is an infant, is not so clear-cut.

Most people are familiar with the concept of organ donation after brain death, but organ donation is also permissible after cardiac death. Cardiac death occurs after life support is withdrawn, and the heart stops on its own. Because the heart can sometimes restart, the Institute of Medicine recommended in 1997 that 5 minutes should elapse between the time the heart stops and the organ retrieval begins. More recently, however, it's been suggested that cardiac death becomes irreversible after just one minute.

Now, in the Aug. 14 issue of the New England Journal of Medicine, surgeons from Denver Children's Hospital report on three cases in infant heart donors where surgeons reduced the time between when the heart stopped and when organ retrieval began. In one case, the time was shortened to three minutes, and in the other two to just 75 seconds.

The reason doctors might want to shorten this interval is to reduce the time that transplantable organs are deprived of oxygen, which likely increases the success of transplants. Doing so might also help increase the number of available organs for donations, which is important because as many as one in four babies awaiting a heart transplant dies while on the waiting list, according to the study.

I wonder how many babies who receive a heart transplant live five years? How many make it this far even if the donor baby did not have cardiac death.

"At the time of the evaluation in 2006, 52 patients (74%) of the transplants patients were alive. The 30-day mortality rate was 6%. The oldest patient was 19 years old and the longest surviving patient was 16 years post-transplantation. For the study population as a whole, the one-year survival rate was 84%; the five-year rate was 65%; and the 10-year rate was 53%."

From here: http://www.docguide.com/news/content.nsf/news/852571020057CCF6852572DB0068D520

One important note: "It was also found that among those patients who underwent transplantation starting in 1996, the survival rates increased to 88% at one year and to 85% at 10 year. For ABO-incompatible patients, all were alive, with 2.5 years being the longest post-transplantation survival."

So more recent transplant patients have better survival rates, presumably due to better techniques and therapies.

I wonder how many make it to one year after they receive the transplant?

See above.

By the way, a dear friend of mine had a baby with serious heart defects. The little boy died at 2 months before he could get a heart transplant. The couple then had 2 more children. One needed heart surgery at the age of 5 and is doing well.

I'm so sorry for your friend. We have a neighbor whose grandson had a transplant at the age of a few months. He is 4 or 5 now and is fine. He goes for frequent checkups and is doing well so far.

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