Carmelo Milano, MD

Expanding the Donor Pool for Pediatric Heart Transplant
Duke University, Durham, NC
Carmelo Milano, MD – $50,000

Cardiac transplantation remains the most effective treatment for children with advanced cardiomyopathy and heart failure that is refractory to medications and associated with marked functional limitation and life expectancy of less than one year. However, the shortage of available heart donors remains a problem. Conventionally, heart transplantation has utilized brain dead (BD) donors who continue to have cardiac function. Although non-cardiac organs from donation after cardiac death (DCD) are being increasingly utilized, DCD hearts are not currently being utilized. Since DCD donors suffer severe brain injury and must be declared dead after cessation of mechanical ventilation and cardiac arrest, there are concerns that ischemia and reperfusion (I/R) injury may occur during cardiopulmonary arrest. Encouraging evidence shows that DCD donors are relatively younger than BD donors making it more suitable for pediatric cardiac transplantation. Furthermore, hearts from BD donors who have experienced cardiac arrest do not portend a negative survival following transplantation. In this proposal, readily available DCD pediatric, DCD adult, and BD donor hearts will be placed on the LifeCradle™ perfusion apparatus and perfused with a solution designed to minimize I/R injury. Samples of perfusate will be tested for biomarker concentration. These hearts will be functionally assessed using a Langendorff working heart apparatus. Comparison of data from the different donor hearts will enable parameters to be developed for determination of heart quality. Ultimately, this work should lead to the development of a clinical protocol for pediatric heart transplantation utilizing a DCD donor.