Despite efforts to improve donor heart allocation policies, geographic disparities, logistical challenges and patient criteria limit organ availability. However, recent surgical innovations offer potential solutions. These include partial heart transplantation and xenotransplantation. Partial heart transplantation is a new procedure with the potential to address several clinical challenges in treating congenital heart defects. Cardiac xenotransplantation involves the transplantation of genetically modified porcine hearts into humans, offering a potential solution to the shortage of donor organs. Although immunologic barriers and ethical concerns remain, ongoing research aims to mitigate the risks and optimize outcomes, providing hope for patients in need. These innovative surgical approaches offer promising avenues for addressing the critical shortage of donor hearts and with ongoing research, may hold the potential to revolutionize heart transplantation, and improve outcomes for patients facing terminal heart failure.
UNOS. Sharing UNfO, unos.org/data (2023, accessed 23 December 2023).
3.
GoffRRUccelliniKLindbladK, et al. A change of heart: preliminary results of the US 2018 adult heart allocation revision. Am J Transplant2020; 20: 2781–2790.
4.
BearlDW. Ethical issues in access, listing and regulation of pediatric heart transplantation. Transl Pediatr2019; 8: 278–283.
5.
ColvinMMSmithJMAhnYS, et al. OPTN/SRTR 2021 annual data report: heart. Am J Transplant2023; 23(2 suppl 1): S300–S378.
6.
CostanzoMRDipchandAStarlingR, et al. The International Society of Heart and Lung Transplantation guidelines for the care of heart transplant recipients. J Heart Lung Transplant2010; 29: 914–956.
7.
VellecaAShulloMADhitalK, et al. The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipients. J Heart Lung Transplant2023; 42: e1–e141.
8.
LinHZhangHLinZ, et al. Review of nutritional screening and assessment tools and clinical outcomes in heart failure. Heart Fail Rev2016; 21: 549–565.
9.
GoldstoneABBachaEASykesM. On cardiac xenotransplantation and the role of xenogeneic tolerance. J Thorac Cardiovasc Surg2023; 166: 968–972.
10.
SkidmoreSHillMABisharaK, et al. Morbidity and mortality of heterotopic partial heart transplantation in rodent models. J Cardiovasc Dev Dis2023; 10: 234.
11.
HenaineRRoubertieFVergnatM, et al. Valve replacement in children: a challenge for a whole life. Arch Cardiovasc Dis2012; 105: 517–528.
12.
HessNRSeeseLMSultanI, et al. Geographic disparities in heart transplantation persist under the new allocation policy. Clin Transplant2021; 35: e14459.
13.
SiddiqiHKSchlendorfKH. Hepatitis C positive organ donation in heart transplantation. Curr Transplant Rep2021; 8: 359–367.
14.
KwonJHHillMAPatelR, et al. Outcomes of over 1000 heart transplants using hepatitis C-positive donors in the modern era. Ann Thorac Surg2023; 115: 493–500.
15.
MacdonaldPSGorrieNBrennanX, et al. The impact of frailty on mortality after heart transplantation. J Heart Lung Transplant2021; 40: 87–94.
16.
Barge-CaballeroEGarcia-LopezFMarzoa-RivasR, et al. Prognostic value of the Nutritional Risk Index in heart transplant recipients. Rev Esp Cardiol2017; 70: 639–645.
17.
DewMADiMartiniAFDobbelsF, et al. The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support. Psychosomatics2018; 59: 415–440.
18.
StevensonLWKormosRLYoungJB, et al. Major advantages and critical challenge for the proposed United States heart allocation system. J Heart Lung Transplant2016; 35: 547–549.
19.
YazjiJHGargPWadiwalaI, et al. Expanding selection criteria to repairable diseased hearts to meet the demand of shortage of donors in heart transplantation. Cureus2022; 14: e25485.
20.
SprengelASkwaraWZiegelhofferT, et al. Combined mitral valve repair and heart transplantation. Clin Case Rep2018; 6: 564–568.
21.
PowerASweatKRRothA, et al. Contemporary pediatric heart transplant waitlist mortality. J Am Coll Cardiol2024; 84: 620–632.
22.
WilliamsRJLuMSleeperLA, et al. Pediatric heart transplant waiting times in the United States since the 2016 allocation policy change. Am J Transplant2022; 22: 833–842.
23.
NguyenSNSchiazzaARichmondME, et al. Trends in pediatric donor heart discard rates and the potential use of unallocated hearts for allogeneic valve transplantation. JTCVS Open2023; 15: 374–381.
24.
MoellerCMValledorAFOrenD, et al. Evolution of mechanical circulatory support for advanced heart failure. Prog Cardiovasc Dis2024; 82: 135–146.
25.
Moctezuma-RamirezAMohammedHHughesA, et al. Recent developments in ventricular assist device therapy. Rev Cardiovasc Med2025; 26: 25440.
26.
MallapatyS. Man survives with titanium heart for 100 days - a world first. Nature2025; 639: 848–849.
27.
RajabTKOchoaBZilinskasK, et al. Partial heart transplantation for pediatric heart valve dysfunction: a clinical trial protocol. PLoS One2023; 18: e0280163.
28.
TurekJWKangLOverbeyDM, et al. Partial heart transplant in a neonate with irreparable truncal valve dysfunction. JAMA2024; 331: 60–64.
29.
AlexanderVSVogelADSilvanoZT, et al. Organizational challenges for partial heart transplantation. Future Cardiol2024; 20: 719–728.
30.
SherardCAtteyaMVogelAD, et al. Partial heart transplantation can ameliorate donor organ utilization. J Card Surg2022; 37: 5307–5312.
31.
KwonJHHillMAGerryB, et al. Cellular viability of partial heart transplant grafts in cold storage. Front Surg2021; 8: 676739.
32.
RajabTK. Evidence-based surgical hypothesis: partial heart transplantation can deliver growing valve implants for congenital cardiac surgery. Surgery2021; 169: 983–985.
MaynesEJO’MalleyTJAustinMA, et al. Domino heart transplant following heart-lung transplantation: a systematic review and meta-analysis. Ann Cardiothorac Surg2020; 9: 20–28.
37.
MohiuddinMMSinghAKScobieL, et al. Graft dysfunction in compassionate use of genetically engineered pig-to-human cardiac xenotransplantation: a case report. Lancet2023; 402: 397–410.
38.
GriffithBPGoerlichCESinghAK, et al. Genetically modified porcine-to-human cardiac xenotransplantation. N Engl J Med2022; 387: 35–44.
39.
GoerlichCESinghAKGriffithBP, et al. The immunobiology and clinical use of genetically engineered porcine hearts for cardiac xenotransplantation. Nat Cardiovasc Res2022; 1: 715–726.
GoerlichCEGriffithBHannaP, et al. The growth of xenotransplanted hearts can be reduced with growth hormone receptor knockout pig donors. J Thorac Cardiovasc Surg2023; 165: e69–e81.
42.
CooperDKCPiersonRNIII. Milestones on the path to clinical pig organ xenotransplantation. Am J Transplant2023; 23: 326–335.
43.
ReichartBCooperDKCLanginM, et al. Cardiac xenotransplantation: from concept to clinic. Cardiovasc Res2023; 118: 3499–3516.
44.
MoazamiNSternJMKhalilK, et al. Pig-to-human heart xenotransplantation in two recently deceased human recipients. Nat Med2023; 29: 1989–1997.
45.
GeorgeAJ. Ethics, virtues and xenotransplantation. Perfusion2024; 39: 334–343.
46.
BouletJCunninghamJW and
MehraMR. Cardiac xenotransplantation: challenges, evolution, and advances. JACC Basic Transl Sci2022; 7: 716–729.
47.
HurstDJPadillaLACooperDKC, et al. Clinical trials of pediatric cardiac xenotransplantation. Am J Transplant2021; 21: 433–434.
48.
CooperDKCPiersonRNIII. The future of cardiac xenotransplantation. Nat Rev Cardiol2022; 19: 281–282.
49.
JayaprasadN. Heart failure in children. Heart Views2016; 17: 92–99.
50.
RajabTKVogelAD and
TurekJW. Partial heart transplantation: a new option for paediatric heart valve replacement. Nat Rev Cardiol2024; 21: 277–278.
51.
VogelADAlexanderVSBrockbankKGM, et al. A future with partial heart transplantation. J Heart Lung Transplant2024; 43: 863–865.
52.
YangBQParkAC and
SchillingJD. Cardiac xenotransplantation: 5 things every cardiologist should know. JACC Basic Transl Sci2022; 7: 518–521.
