'Pioneering' heart transplant on two-month-old baby with 'incompatible blood-type donor'

A TWO-MONTH-OLD baby girl has made international headlines after undergoing a pioneering life-saving operation.

Not only is Naiara the youngest patient to receive a heart transplant to date, but she is also the first to receive an organ from a donor of an incompatible blood type.

And the donor heart was shipped over by aircraft, along with the team of surgeons – yet another first for the infant and for Spain's medical history.

It was what is known as an 'asystole' donation, or where the donor's heart had stopped, meaning the organ was kept 'alive' through an exterior circulation system enabling oxygen to flow through it.

As the organ came from a different – and undisclosed – region in Spain to where the baby was based, the entire cardiology surgery team from Madrid's Gregorio Marañón Hospital had to be flown to the site. 

They then returned with the frozen organ to carry out the transplant.

Regional health authorities in Madrid say this is the first time an organ had been implanted in a child based some distance from its origin.

Also, the donor and baby Naiara are of incompatible blood type, or 'AB0 incompatible', making the procedure even more complex.

In fact, three years ago it would have been 'impossible', the health authority said, since a system had not been designed for transplants between donors of the wrong blood groups.

“The difference with an 'asystole' donation is that the surgeon finds a heart which has stopped, has been some minutes without beating, but is still warm, so we have to revive the heartbeat through external means by connecting the organ to an outside system,” explains paediatric cardiologist Dr Juan Miguel Gil Jaurena, leading the Gregorio Marañón team.

“Until relatively recently, nobody would have considered that a person with no heartbeat could donate their heart, even if the beat was recovered artificially.”

After this process, the actual transplant operation and follow-up care are the same as for a 'traditional' organ implant, Dr Gil Jaurena says.

This factor, and the success of the surgery despite a lack of a blood-type match, means a greater likelihood of very small children and babies who need transplants getting the organs they need, since donations from infants and toddlers are rare.

Before Naiara was born, a scan showed she had heart problems, which worsened as her mother's pregnancy progressed, so the infant was referred – pre-partum – to the children's cardiology unit at the Gregorio Marañón and her birth was induced early.

Once she came into the world, the medical team managed to stabilise her heart so that, along with her other organs, it could mature and develop.

This was when the option of a transplant was mentioned – although it was the only option available to save her, and chances were very slim as donors of just a few weeks or months old are extremely hard to find.

“Thanks to the immense generosity of other parents, a heart became available for Naiara,” said the head of the paediatric cardiac transplant unit, Dr Manuela Camino.

Naiara spent several weeks in neo-natal intensive care and, when her condition had improved sufficiently, was moved to a mainstream ward, where she is said to be recovering well.

It is not clear when she will go home, but this is likely to be fairly soon, and she is expected to be able to lead a normal life.