AI Article Synopsis
- Cardiac allotransplantation is crucial for treating end-stage heart failure, but the shortage of organs, especially for pediatric patients, complicates access and increases wait times.
- The text discusses how donation after circulatory death combined with normothermic regional perfusion can enhance organ availability for children, while addressing the technical, ethical, and logistical factors involved.
- Despite the growing use of this method in the U.S., ethical concerns about cerebral blood flow remain, highlighting the need for standardized protocols and training to improve the success of these organ procurement techniques and ultimately reduce pediatric mortality rates.
Article Abstract
Background: Cardiac allotransplantation is the optimal treatment for end-stage heart failure. However, organ supply remains the principal issue impacting patients. Pediatric patients present unique challenges resulting in long wait-list times and increased mortality. Donation after circulatory death with normothermic regional perfusion represents a method to increase the number of available organs in this population.
Methods: Multi-institutional expert consultation was sought to outline extant technical, ethical, and logistical issues with regard to normothermic regional perfusion cardiac donation techniques. Specific advantages in the pediatric population are highlighted, as well as technical considerations resulting in successful organ procurement.
Results: Utilization of donation after circulatory death organs following normothermic regional perfusion in the United States is increasing and offers advantages to the pediatric heart failure population. Ethical reservations both nationally and abroad persist, namely pertaining to cerebral blood flow. This has led to variation in perception and utilization of normothermic regional perfusion, contributing to a discrepancy between donor and recipient locations. Procurement techniques and variations are described, with introduction into program planning and protocol development. Training in technical aspects of the procedure is paramount for both the surgeon and support staff to construct a successful program, along with transparent protocols to mitigate ethical concerns.
Conclusions: Normothermic regional perfusion is relevant following donation after cardiac death in the pediatric population. Ethical and technical challenges remain in concert with substantial domestic and international variation. Standardization of technique may serve to increase future use and increase the number of available hearts for transplant, reducing pediatric mortality.
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| http://dx.doi.org/10.1016/j.athoracsur.2024.11.026 | DOI Listing |
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Article Synopsis
- Cardiac allotransplantation is crucial for treating end-stage heart failure, but the shortage of organs, especially for pediatric patients, complicates access and increases wait times.
- The text discusses how donation after circulatory death combined with normothermic regional perfusion can enhance organ availability for children, while addressing the technical, ethical, and logistical factors involved.
- Despite the growing use of this method in the U.S., ethical concerns about cerebral blood flow remain, highlighting the need for standardized protocols and training to improve the success of these organ procurement techniques and ultimately reduce pediatric mortality rates.
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