Background: The gold standard for treatment of patients with end-stage heart failure remains heart transplantation. Time spent on the active waiting list, notably for pediatric patients, contributes to alarmingly high mortality. Donation after circulatory death (DCD) marks an evolution in heart transplantation that has proven to expand the donor pool and shorten waitlist times in adult heart recipients. Normothermic regional perfusion (NRP) is a procedure where veno-arterial extracorporeal membrane oxygenation is initiated after clamping the head vessels to reperfuse and reanimate the heart after cardiac death. NRP also allows the procuring team to evaluate heart function in vivo to determine organ suitability after warm ischemia.

Results: DCD NRP has allowed our team to procure pediatric hearts in donors as small as 3 kg.

Conclusions: DCD NRP is a viable technique to increase the cardiac donor pool in even the smallest donors with the right team, resources, and adequate planning.