Pediatric Heart Transplantation from Completely Dead Donor

Pediatric heart transplantation from a completely dead donor, also known as donation after circulatory death (DCD), represents an important and evolving advancement in the field of congenital and pediatric cardiac surgery. Traditionally, pediatric transplants have relied on hearts procured from donors declared brain dead, but the severe shortage of suitable organs has led to growing interest in DCD as a viable alternative. In DCD, the donor is declared dead following irreversible cessation of circulatory and respiratory function, after which the heart is carefully recovered and resuscitated using ex-vivo perfusion or regional normothermic reperfusion techniques. These methods allow assessment and preservation of the organ’s function before transplantation, expanding the donor pool and offering critically ill children—many of whom have no alternative treatment options—an increased chance of survival. Despite ethical and logistical challenges, early outcomes have been promising, and ongoing innovations are making pediatric DCD heart transplantation a transformative strategy in addressing the pediatric donor heart shortage.