Heart transplants in infants: an estimate of need and restrictions

The need for cardiac transplantation in children in the Netherlands can be estimated at 5-14 per year, including 1-3 in newborns. This treatment can only be successful in close cooperation with an existing programme for adult cardiac transplantation and in a centre where the surgery for congenital heart disease is performed to its complete extent. Heart transplantation should not be the primary treatment for hypoplastic left heart syndrome as the Norwood operation constitutes a good alternative. Donor shortage is a problem for children also. In the treatment of endstage heart disease in newborns, owing to ethical dilemmas, surgical treatment is not a matter of course.