When Luke Cowdell was born, the nurses noticed he didn’t have the pink hue of a healthy baby boy.
Because of a heart defect, blood wasn’t coursing to his hands and feet. When emergency surgery failed, the only option was a heart transplant.
He received a transplant like few others. In October, Emory University surgeons placed the wrong blood type heart into the baby’s body. On purpose.
Today the 5-month-old Moreland, Ga., boy is healthy and happy. He’s one of only a few dozen children in the world to receive a heart that’s incompatible with his body. Doctors say procedures like this may keep more babies alive.
Luke, who is blood type O, received a type A heart in a procedure that goes against the grain of years of transplant experience.
Past practice would call for waiting until a type O heart was available. “We were quite fearful he would not last that long,” says Dr. Kirk Kanter, the Emory heart surgeon who performed the transplant.
The ability to use a different blood type organ doubled the child’s chances of survival, Kanter said.
Not widely accepted
Beyond infancy, implanting incompatible organs can be deadly, as it was in the case last year of 17-year-old Jesica Santillan. Duke University Hospital surgeons accidentally implanted the wrong blood type heart and lungs, which her body rejected.
Still, the findings aren’t widely accepted, with only nine U.S. medical centers performing such transplants for a dozen infants, said Joel Newman of the United Network for Organ Sharing.
Infant hearts are scarce and proponents say the procedure allows more donor hearts to be matched with babies who need them.
The diminutive size of the organ — about the size of a strawberry — rules out transplants from older children. It takes about 52 days for a child on a waiting list to receive a transplant. Last year, 27 babies died waiting.
The donor pool also is small. An infant must be brain-dead to be a potential donor candidate, a condition that typically occurs after car accidents or drownings.
There were 82 heart transplants in infants under age 1 last year. Twenty children that age are on the current heart transplant waiting list, according to the organ network.
“It takes a long time to find a reasonable donor for a newborn, and to really add insult to injury, if you use classic heart transplant principles, the blood groups have to match,” said Kanter, director of the heart and lung transplant program at Children’s Healthcare of Atlanta.
Equal survival rates
Under traditional thinking, that means those who are blood type O can only receive a type O heart. Types A or B infants can receive hearts from the same blood type or from type O. Types AB are compatible with all blood types.
Despite West’s research, U.S. transplant matchers still follow standard policy first for infants, seeking an exact match before releasing an organ for use in a baby with a different blood type. In Luke’s case, no other child needed a type A heart.
“There still is some reluctance — I think cases like Dr. Kanter’s are forging the way,” said West, who is medical director of the transplant program of the Hospital for Sick Children. “They are starting what will become an eventual acceptance. The (blood type) barrier in transplantation is such a big barrier, they have to be really convinced before proceeding.”
Transplant network officials endorsed West’s method in 2001 after medical data showed the procedures’ survival rates were the same as traditional infant heart transplant surgery.
The policy “made it explicit in the case of infants less than 1 year of age, the blood type could be crossed without necessarily harming the recipient,” Newman said. “It’s done to make sure every organ available is used. It is up to the individual hospital whether to accept offers to do this.”
Despite the policy and the medical findings, many hospitals are still discussing whether to adopt the procedure.
“It is new and it is different and doctors, by definition, don’t like doing things that are new and different,” said Dr. Mark Boucek, director of the transplant program at The Children’s Hospital in Denver.
More data on successful transplants and the long-term health of such babies are needed, said Boucek, also professor of pediatrics at the University of Colorado. He said his hospital has placed a few children on incompatible blood type waiting lists, but each time a compatible heart was found.
Still, the procedure made all the difference for Luke, said his mother, Jenny Cowdell.
“It’s just been a miracle for us that he’s been doing so well — he looks and acts like a normal baby,” she said. “He’s been doing great — today he rolled over for the first time, all the way over. I said, ’Oh, no, he’s getting mobile.”’
