Pediatric heart transplants

Many babies are born with heart defects or hearts which are not fully developed. These conditions are called congenital heart defects and are common in babies who are extremely premature or those with Down’s  Syndrome.

It is estimated that 1 in every 100 babies is born congenital heart defect. In the US, about 2 million people of different ages have some form of congenital heart condition. Thanks to medical advances, what were declared as “death sentence cases” half a century ago can now be  corrected surgically.

However, some of these conditions are beyond surgical repair, so that a heart transplant is the only chance for survival.

Pediatric heart transplantation is very complicated because of the urgency of many cases. Only hearts of babies of similar age can be transplanted. There is quite a shortage of pediatric hearts for transplantation and most often the patients die before a suitable heart donor can be found. According to a study by Curfman and colleagues, infants have10 times the risk of dying while waiting for a heart compared to adults. Up to 50 babies which are placed on the heart transplant waiting list everywhere do not survive the wait.

According to the same study, about 400 heart transplants are performed in children and adolescents in the US every year. In approximately two-thirds of all cases, the cause of heart malfunction is inoperable congenital heart disease. The remaining one third are due to advanced cardiomyopathy.

Of the 400 pediatric heart transplantations performed annually, about 100 are in infants under the age of 1 year. The 15-year survival rate among these infants is greater than 50%, increasing to 80% among those who survive for the first 5 years after transplantation. Thus, cardiac transplantation in infants is a highly successful procedure that has saved the lives of many babies with terminal heart disease.

A new study described 3 cases of infants implanted with heart from other infants pronounced dead based on cardiac death criteria. (For a review of cardiac death criteria, check out this previous post.) This report may trigger 2 things: a) hope for patients waiting for a heart

b) ethical questions on death criteria.

If indeed, lost heart function is reversible even after death, so that even a “dead” heart can be restarted again to beat in another person’s body, then there is hope for many heart patients out there that more heart transplants can be performed. But if a supposedly “dead” heart be revived, are we giving up too early on the donor’s chances of survival? In other words, are we saving one life at the expense of another?

I am for organ donation. I have an organ donor card that I carry with me all the time. I am also a mother of 2 young children and like all parents, I wouldn’t want to be in a situation when I have to sign over a family member’s organ to another person. However, it could also happen that I would be on the waiting end of the chain – waiting for organ procurement for a chance for a loved one to live longer.

The line between life and death is blurred and never easy to define. And even the most advanced of technologies can never answer the question.