Jose Angel ZamoranoCardiovascular perfusionist, Spain
Title: Donation in neonatal asystole with myocardial recovery and subsequent incompatible ABO heart transplant. First combined case in the world
Introduction: The lack of pediatric donors has driven the development of alternatives to increase the possibility of transplantation of child patients on the waiting list. In this context, Pediatric Controlled Asystole Donation is presented as a valuable possibility to increase the number of potential donors.
Case Description: It is a patient of 2 months and 3.1 kg of weight. He was born with 1.9 kg and uncompacted ventricles. His ejection fraction was 20%, he was intubated and with inotropic. The blood type of the receiver was B. A distant hospital 340 km offered us a donor of 3 days and 3.4 kg of weight blood group A, with brain damage from perinatal asphyxia. The parents accepted the donation in asystole. Both centers have programs of cardiac surgery, transplantation and donation in controlled asystole.We perform the procedure using medial sternotomy, central cannulation and extracorporeal circulation. Previously, the times recorded between withdrawal of life support and cardiac arrest were 37 minutes. The interval between the skin incision and the start of the assistance was 7 minutes. After 32 minutes of extracorporeal circulation, the graft was extracted. The total cold ischemia lasted 245 minutes, without circulatory assistance during the transfer of the graft. After the transplant there were no episodes of rejection and the patient was discharged 10 weeks later.
Discussion: This is the first case of donation in neonatal controlled asystole and with remote extraction without assistance in the transfer. We suggest extracorporeal circulation and central cannulation as an expeditious strategy in children. The asystole donation program can be added to the blood group incompatibility program, both protocols could help increase donations in children under one year.
To be updated