Newswise — A heart 'domino' transplant involving the youngest living heart donor occurred Jan. 14, 2006 at Columbus Children's Hospital in Columbus, Ohio. Four-month-old Jason Wolfe of Fairfield County, Ohio, received a combined heart, double lung transplantation from an out-of-state donor. In turn Wolfe's heart, the domino heart, was donated to 12-week-old Kayla Richardson of Franklin County, Ohio.

Domino heart transplantation occurs when one patient undergoes heart-lung transplantation, and his/her original heart is then given to a second heart-transplant recipient. The opportunity for this procedure can occur when the heart-lung recipient's original diagnosis included a primary pulmonary disease, but with a functionally normal to near normal heart. This procedure may be the only opportunity that a critically ill heart transplant candidate may have to receive a donor heart.

Wolfe was born Sept. 30, 2005 a healthy baby boy. His parents, Michael and Maria Wolfe, had noticed Jason was having difficulty breathing, a bluish tint to his body (cyanosis) and that he was not eating well. Concerned, the Wolfes took their son to the pediatrician Dec. 27. One week later (Jan. 2), Jason Wolfe was transported from a local hospital to Columbus Children's Hospital. Within 24-48 hours at Children's, Wolfe's condition rapidly deteriorated and was placed on the lung transplant list Jan. 12 with the United Network of Organ Sharing (UNOS). The diagnosis was primary pulmonary hypertension. Pulmonary hypertension is a commonly missed diagnosis among infants because in newborns it is actually fairly common, but usually transient. Unlike adults, the symptoms can remain hidden for the first several weeks to months prior to diagnosis.

Richardson was born Nov. 8, 2005 to parents Robert Richardson and Rebecca Lovins. Kayla was born with pulmonary atresia and abnormal coronary arteries. Although congenital heart disease can occur in about one percent of newborns, Richardson's type of heart anomaly is very rare and caused the right side of her heart to not fully develop. Richardson was admitted to Children's Dec. 15 critically ill and eventually experienced a cardiac arrest. She was placed on ECMO, a heart-lung bypass machine, which she remained on for 10 days. Richardson was placed on the heart transplant list Jan. 4, with a prognosis of just weeks to live.

Finding a suitable match for both Wolfe and Richardson was especially challenging due to the need for small infant organs. A heart-lung match for Wolfe was located late the night of Friday, Jan. 13 from an out-of-state donor. Because of the suitable match and Wolfe's blood type, he had the opportunity to become a universal heart donor. The Wolfe and Richardson transplant teams saw the opportunity for a heart domino transplant and immediately began the process of approval.

"It was important that everyone, from the hospital leadership all the way through the hospital staff, were aware and comfortable of the unique nature of this case," Mark Galantowicz, MD, Co-Director of the Heart Center, Chief of Cardiothoracic Surgery, Director of Cardiopulmonary Transplantation at Columbus Children's Hospital, and Associate Professor of Surgery at The Ohio State University College of Medicine, said. "We had detailed conversations with the Wolfe family and told them how we were faced with a new twist " would they be willing to donate Jason's heart to save the life of another patient (Kayla Richardson) that they actually knew in part of a heart domino transplant?"

Transplantation is typically anonymous. Because Wolfe and Richardson were critically ill and housed in the same unit at Children's, both families knew of the other. With approval from both parties involved and hospital leadership the stage was set for the heart domino transplant.

Galantowicz began the transplant operation on Wolfe in preparation for the arrival of the procured donor heart and lungs.

"A heart-lung transplant was performed on Wolfe because at his age and size there is a lower risk of airway complications than a sequential double lung transplant," Todd Astor, MD, Columbus Children's Transplant Pulmonologist and Medical Director of the hospital's Lung and Heart-Lung Transplant programs, and Assistant Professor of Clinical Pediatrics at The Ohio State University College of Medicine, said. "In a heart-lung transplant the heart and lungs remain attached, and connections between the larger airways and blood vessels result in fewer complications. The rejection and infection rates are similar after heart-lung transplantation when compared to lung transplantation."

While Galantowicz was transplanting Wolfe, Children's Heart Center Cardiothoracic Surgeons Alistair Phillips, MD and Terry Davis, MD prepared Richardson to receive Wolfe's heart and transplanted the donor heart.

"It was an extraordinary Friday the 13th," Galantowicz said. "The domino heart transplant is a very unusual situation where you have two patients in severe need of transplantation in the same institution. Because both are of similar size (so that the organs would fit) and of the same blood type it was an appropriate transplant."

Between both surgical and transplant teams there was continuous communication with the goal of minimizing the time between removing Wolfe's heart and transplanting it in Richardson. Wolfe and Richardson's combined surgical procedures lasted approximately 12 hours. Both are currently in the cardiac intensive care unit (CICU) at Columbus Children's Hospital.

"Columbus Children's is one-of-five pediatric facilities in the country with the capabilities and staff to have attempted this procedure," Timothy Hoffman, MD, Columbus Children's Transplant Cardiologist and Director of the hospital's Heart Transplant and Heart Failure programs and Assistant Professor of Clinical Pediatrics at The Ohio State University College of Medicine, said. "Without a collaborative team effort, this procedure would not have occurred."

Columbus Children's Hospital has become a regional pediatric center for solid organ, blood and tissue transplantation. Whether battling late-stage organ failure, organ-destroying disease or inherited conditions, patients at Columbus Children's Hospital have access to the highest quality of transplant teams and every essential support service that must accompany successful transplantation. The Transplant Program at Children's is comprised of Lung Transplant, Heart Transplant, Heart-Lung Transplant, Blood and Marrow Transplant and Kidney Transplant.

Columbus Children's has built a comprehensive and multidisciplinary lung disease program, offering lung and heart-lung transplants. This fully accredited, UNOS-approved program is home to a tremendously experienced team of subspecialty surgeons and physicians, transplant coordinators, advance practice nurses, occupational therapists, physical therapists and others.

The Heart Center at Columbus Children's Hospital is a world-class diagnostic treatment and research facility for pediatric and adult patients with all forms of congenital heart disease and acquired cardiomyopathy. By consolidating all cardiology and cardiothoracic surgery services, the Heart Center has created a comprehensive model for family-centered care and convenience.