AVAILABILITY AND SELECTION OF DONORS FOR PEDIATRIC HEART-TRANSPLANTATION

Methods: Applying generally accepted criteria for selection of adult h eart donors, we conducted a retrospective study of brain-dead infants and children for assessment of suitability as donors for heart transpl antation. Cardiac histopathologic studies were evaluated in all subjec ts undergoing autopsy. Results: In 5 years there were 58 such patients , the majority of whom had head injury, near-drowning, near-miss sudde n infant death syndrome, infection, or asphyxia. Of these, only five m et the proposed clinical criteria. Most prospective donors were elimin ated on the basis of prolonged cardiac arrest (n = 33), pressor depend ency (n = 25), and/or infection (n = 10). Forty-two subjects underwent autopsy, of whom 36 would not have been excluded as donors except on the basis of ischemic cardiac insult. Of these, 18 subjects were found to have essentially normal myocardium, nine had abnormal but potentia lly reversible microscopic changes, and nine had myocardial infarction . The pathologic findings were not predicted by the selection criteria , but severe chest trauma was not associated with infarction, eight of the nine patients with infarction had had cardiac arrest, and most of those with infarction had drowned or had had sudden infant death synd rome. Conclusions: The supply of donor organs for pediatric heart tran splantation is very limited if selection criteria used for adult donor s are applied. These criteria, however, do not correlate well with myo cardial pathologic findings in infants and children. More accurate pre dictors of donor suitability are needed.