Virtual Heart Transplantation Matches More Organs to Recipients in Need

Published March 2019 | The Journal of Heart and Lung Transplantation

For heart transplantation, achieving a close size match between a donor organ and the space within a recipient’s chest cavity is crucial to success, yet can be especially challenging to achieve when working with children.

In fact, this challenge has meant that children with end-stage heart failure face the highest waiting list mortality in all of transplant medicine. Now, size-matching complexities have become easier to solve thanks to a three-dimensional virtual reality process developed at Cincinnati Children’s.

Lacking uniform standards for organ sizing, transplant groups generally use body weight to guide donor selection. However, body weight does not consistently reflect chest cavity size.

The new study, led by first author, Nicholas Szugye, MD, and senior author, Ryan Moore, MD, compared four transplant patients with dilated cardiomyopathy (DCM) against a virtual pool of 25 potential donors.

The team found that virtual sizing enabled more donor organs to be acceptable for transplantation. On average, virtual transplantation yielded a maximum donor-recipient ratio of 2.15 or 215% of recipient weight, much higher than thresholds set at most institutions.

Calculating 3D total cardiac volume (3D-TCV) requires importing chest CT imaging data into a 3D visualization software program—including measurements for bones, lungs, heart, great vessels, systemic veins, and pulmonary veins. A candidate organ was considered a fit if it did not interfere with the anterior chest wall or impinge on the descending aorta, left main stem bronchus, left pulmonary veins, or lung parenchyma.

“If virtual transplantation is used, the number of acceptable donors for each patient will increase proportionally with the size of the heart rather than the weight of the child,” the co-authors state.

Co-authors included Angela Lorts, MD, Farhan Zafar, MD, Michael Taylor, MD, PhD, and David Morales, MD.

An image showing a 3-D reconstruction of a heart and chest cavity.

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A photo of Nicholas Szugye, MD.

Nicholas Szugye, MD

A photo of Ryan Moore, MD.

Ryan Moore, MD


Szugye NA, Lorts A, Zafar F, Taylor M, Morales DLS, Moore RA. Can virtual heart transplantation via 3-dimensional imaging increase the maximum acceptable donor size? J Heart Lung Transplant. 2019 Mar;38(3):331-333.