Identifying potential heart donors among newborns undergoing circulatory determination of death

Background: Infants younger than 1 year old have the highest heart transplant wait-list mortality. Transplantation from donors after circulatory determination of death (DCDD) is an innovative new option for these patients. We examined the potential for heart donation in neonatal intensive care unit (NICU) patients undergoing elective withdrawal of life support.

Methods: Medical records of all patients who died between June 2003 and June 2008 in our 84-bed NICU were reviewed. The mode of death among potential organ donors (weight > 2.5 kg) was categorized into 4 groups: Died despite cardiopulmonary resuscitation (CPR), do not resuscitate (DNR) status, brain death, or withdrawal of life support. Patients undergoing planned life-support withdrawal were evaluated for DCDD potential.

Results: Of 266 NICU deaths during the study period, 117 patients weighed more than 2.5 kg at the time of death, of whom 15 (13%) died despite CPR, and 33 (28%) were DNR. No brain deaths occurred; consequently, no conventional organ donation resulted. Of 69 infants (59%) who died after withdrawal, 53 were excluded as potential donors due to active infection, cardiac dysfunction, or congenital heart disease. Among the remaining 16, median time from withdrawal to death was 31 minutes (range, < 1-310 minutes). Five infants (4.3% of deaths in babies > 2.5 kg) died within 30 minutes, had good cardiac function, and could have been potential DCDD heart donors.

Conclusions: Among NICU patients withdrawn from life support during a 5-year period, 4.3% would have been suitable heart donors after circulatory determination of death. Implementing a NICU DCDD program could markedly expand the donor pool and reduce short-term wait-list mortality for infant heart transplantation.