Riyadh Hospital Uses One Donor Heart to Treat Two Children

King Faisal Specialist Hospital and Research Centre in Riyadh has treated two children using a single donor heart in what it says is the first paediatric domino heart transplant of its kind in the Middle East and Europe.

The procedure began with a 12-year-old boy suffering from dilated cardiomyopathy and end-stage heart failure, who received the donor heart after spending around six weeks in hospital on continuous medication while awaiting transplantation. Although he required a complete heart transplant, his own pulmonary valve and root remained healthy and were preserved for use in a second child.

That second patient, a nine-year-old boy with severe aortic stenosis and regurgitation, had previously undergone two procedures to repair his affected valve. He underwent a Ross procedure, in which his healthy pulmonary valve was moved into the aortic position to replace the damaged valve. The now-vacant pulmonary position was then reconstructed using the healthy pulmonary valve and root taken from the first child’s explanted heart.

The approach, known as domino heart transplantation, is designed to maximise the therapeutic value of a single donation by using viable tissue from the transplant recipient’s removed heart to treat another patient. Because the transplanted valve is living tissue, it has the potential to grow with the child, which may reduce the need for repeated replacement surgery compared with conventional prosthetic valves that remain fixed in size.

The hospital said the procedure required simultaneous coordination between teams specialising in heart transplantation, paediatric and congenital cardiac surgery, paediatric cardiology, heart failure, cardiac imaging, anaesthesia and critical care, supported by perfusion, nursing and transplant coordination teams responsible for assessing, preserving and preparing the cardiac tissue for transplantation.