‘Happy, scared and anxious’: Duke performs first pediatric DCD heart transplant

A Duke medical team successfully performed the first donation after circulatory death (DCD) heart transplant in a pediatric patient last month, expanding the potential heart donor pool.

The pediatric patient was 14-year-old Jaynzra “Nae” Rice. Rice was admitted to Duke earlier this year with breathing difficulties and was given a left ventricular aid that helps the heart pump, according to a Duke Health press release.

About three months after being discharged from the hospital, the family received news that Rice was eligible for the first DCD pediatric heart transplant. Rice’s mother, Brandaline Rice, said she was overjoyed.

“I felt blessed that she could get a new heart and be the first to go through this so that many children have the opportunity to have this at their disposal,” Brandaline Rice said.

Andersen hopes this first transplant will kick-start this technology in pediatrics and motivate others to continue using it. This technique could increase the number of heart transplants performed by 50%, Andersen said, “allowing more children to get heart transplants and get them sooner.”

Nae Rice’s existing heart pump made the surgery more difficult, Andersen said. But because he was on the same medical team he worked with for previous transplants, the pressure eased.

Meanwhile, Brandaline Rice felt a rollercoaster of emotions.

“I was happy, scared and anxious — until I knew the surgery was over,” Brandaline Rice said.

Although Nae Rice has some breathing problems after surgery, she is strong and will continue to recover, Brandaline Rice said.

“She’s just rolling with the punches, so she’s ready to get back to some normalcy,” she said. “She likes school and she likes driving the bus; she is ready to get back on the school bus.”

Turek and assistant professor of surgery Benjamin Bryner retrieved the donor heart. Assistant Professors of Surgery Nick Andersen and Jacob Schroder were the lead surgeons for the procedure, which took place Aug. 31.

How the transplant works

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The main difference between traditional heart transplants – known as donation after brain death transplants – and DCD is the procurement of the heart from the donor.

Previously, DCD hearts could not be used due to damage incurred during purchase.

Now, using organ preservation technology approved by the Food and Drug Administration of the company TransMedics, the heart is recovered from a deceased donor without cardio-respiratory function and circulated with warm, oxygenated blood to maintain pumping action.

Duke is a pioneer in DCD surgery, having performed more than 50 adult DCD heart transplants since the first in December 2019. However, the first procedure in a pediatric patient was particularly exciting because it was “very difficult to get pediatric patients into trials”. according to associate professor of surgery Joseph Turek.

“It’s just a limitation of pediatrics, so it’s really exciting to be a part of something that can help get kids started,” Turek said.

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