On Jul. 16, 2025, Duke Health has pioneered a world’s-first technique that could expand by up to 20% the donor pool for pediatric heart transplants in the U.S. — offering new hope to families on the waitlist. The New England Journal of Medicine published the case study. It details a groundbreaking approach to overcome barriers to heart donation after circulatory death (DCD) in infants.

DCD is a technique which allows for heart donation to take place after a circulatory death, rather than brain death (once the standard in donation), as long as the functionality of the heart can be assessed on a perfusion device. DCD has previously been used in adult and adolescent transplants, but existing perfusion devices are too large to fit infant hearts.

A technique called normothermic regional perfusion (NRP) could reanimate the heart inside of the body, but it carries logistical and ethical barriers – leading many centers to avoid using it. The lack of NRP uptake causes viable pediatric donor hearts to go unused.

To overcome this, the Duke team developed a novel technique that temporarily reanimates the donor heart outside of the body, on a surgical table using a heart-lung machine (extracorporeal membrane oxygenation or ECMO) – allowing surgeons to assess the organ’s viability before transplant. The approach avoids the barriers associated with NRP and could become a new standard of care.

Duke scientists are calling the new technique on-table heart reanimation. The first-of-its-kind case saved the life of a then 3-month-old patient, who received the procedure earlier this year.

Every year in the U.S. about 700 children are added to the waitlist for a pediatric heart transplant, and of those about 10-20% die while waiting on the list, according to the United Network for Organ Sharing.

Duke Health has a history of pioneering research in DCD hearts transplants, performing the nation’s first DCD heart transplant in an adult in 2019 and the first in an adolescent in 2021.