Limitations Of High Urgency Listing – Ventricular Assist Device Support in a Neonate for 452 Days

Abstract

The Eurotransplant International Foundation in Leiden, the Netherlands, is responsible for mediation and allocation of organ donation procedures to its member countries Austria, Belgium, Croatia, Germany, Luxembourg, the Netherlands and Slovenia. To provide organs for the patients who require urgent transplantation, the "high urgent (HU)" status was introduced in 2001 in Germany . This new HU allocation system is applicable to neonates as well as adults. However, waiting times on HU status exceed several weeks to months. Therefore an increasing number of pediatric patients has to undergo implantation of a ventricular assist device (VAD). In the present report we discuss the current Eurotransplant heart allocation system for pediatric heart transplantation in the light of a neonate with 452 days on mechanical support. We compare the average waiting time of patients on HU status at our center and their outcome in 2007 and 2008 (Data obtained from Eurotransplant International Foundation). Waiting time on HU status in our center increased significantly from 2007 to 2008. Therefore more patients require VAD support as bridging to transplantation. The case of a neonate under long-term VAD support is an outstanding example of the negative effects of this development.

Heart transplantation surgery in children and young adults with congenital heart disease

“…Nonetheless, the 30-day mortality (10.8% vs. 13.5%, p = 0.62) and overall survival (log-rank p = = 0.57) was similar between adult CHD patients with and without VAD support before transplantation [ 33 ]. Another study also showed comparable post-transplant outcomes in pediatric and adult CHD patients with and without VAD support [ 25 ]. CHD patients who receive VAD support have a poor medical status, which implies that VAD support can mitigate certain risk factors before transplantation.…”

“…Later, mechanical circulatory support (MCS) was limited to Novacor and Medos ventricular assist devices before the Berlin Heart® device was launched. In 2010, our working group reported about a neonate who needed circulatory support with an Excor System (Berlin Heart®) for 452 days before successful transplantation [ 25 ]. Increasing life expectancy due to improved ventricular assist devices implies that many CHD patients are supported with a VAD system before heart transplantation.…”

“…In a CHD neonate supported with VAD and listed with a high urgency status for transplantation in our cohort, the long waiting time of 452 days was also a piece of definite evidence [ 25 ]. These findings suggest that VAD should be considered a treatment option for CHD patients before heart transplantation, and a dedicated heart transplant guideline is advocated for CHD patients.…”