A pioneering surgical method developed by Duke Health may significantly expand the number of infant heart transplants in the U.S. This method potentially increases the donor pool by as much as 20%. The technique represents a breakthrough for babies who otherwise lack access to certain types of donor hearts.
The novel approach—dubbed “on-table heart reanimation”—addresses a key barrier in pediatric transplants. That is, the difficulty of assessing donor hearts that have undergone circulatory death (DCD). In traditional donation, organs are recovered after brain death; DCD involves donation after circulation stops. While DCD methods have been used in adults and adolescents, current perfusion systems are too large to support infant hearts.
Normothermic regional perfusion (NRP) is an existing method that can reanimate a heart inside the donor body. However, it presents ethical, logistical, and procedural hurdles that limit its use. To sidestep these challenges, the Duke team developed a method to reanimate and evaluate the heart outside the body—directly on the surgical table using an extracorporeal membrane oxygenation (ECMO) circuit. This allows surgeons to verify whether the organ is functioning properly before proceeding with transplant.
Success in practice
The first successful implementation of this method was done on a 3-month-old earlier in 2025, and it saved the child’s life. Joseph Turek, M.D., Ph.D., head of pediatric cardiac surgery at Duke and senior author of the study, explained that the idea was born of necessity: many donor infant hearts are currently discarded because centers are unable to reliably assess their viability after circulatory death.
“On-table heart reanimation could dramatically expand the availability of precious donations—transforming loss into life,” Turek said in a statement. Based on the number of pediatric donor hearts currently going unused, Turek and his colleagues estimate that this method could save dozens of lives each year.
In the U.S., roughly 700 children are added annually to the pediatric heart transplant list. Of them, 10–20% die while awaiting a suitable donor. By offering a pathway to assess hearts that would otherwise be discarded, the new technique may markedly reduce waitlist mortality in infants.
Duke has background in leading-edge DCD work, having carried out the nation’s first adult DCD heart transplant in 2019 and its first adolescent DCD in 2021. Turek’s other innovations include partial heart transplant, living mitral valve replacement, and co-transplantation of thymus and heart to promote immunological tolerance.
The published case report provides a roadmap for how other centers might adopt the method. While further validation will be required, the team views on-table reanimation as a possible new standard for infant heart donation.
If adopted, the innovation could reshape pediatric transplants—offering hope to families who facing limited options for their sickest infants.
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