Donor Selection And Procurement

Like adult recipients, children are wait-listed through the regional organ bank and the United Network for Organ Sharing (UNOS). Each listing is specific for ABO compatibility and a certain weight range. In a few rare instances of fetal diagnosis of irreparable cardiac anomaly, babies are listed while still in utero with a plan to emergently deliver the child by C-section if a heart becomes available. If the strict size-matching criteria based on the adult experience were used, the supply of donor organs for children would be prohibitively small. We and other centers have, therefore, accepted organs from donors that are 0.8-2.5 times the recipient weight. Fullerton and colleagues reported success using hearts from donors over 3 times the recipient weight.8 Evaluation of the donor function is made by assessing the donor hemodynamic status and degree of inotropic support along with the echocardiographic analysis. Final judgement of donor suitability is reserved for the visual inspection at the time of harvest. Diagnosis of cardiac donors that have been used at Children's Memorial Hospital included motor vehicle accident with head trauma, gunshot wound to the head, other head trauma, intracranial event, sudden infant death, and birth asphyxia. The cardiac harvest is performed through

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