Vanderbilt Surgeons Transplant Children as Young as 2 Days Old Using Donor Hearts Recovered with Cold Oxygen Flush

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The hospital said Oct. 7 that five children, ages 2 days to 14 years, received hearts recovered with the technique in a series reported in the New England Journal of Medicine, and that five more children have been treated since.

The method is called REUP, short for rapid recovery with extended ultraoxygenated preservation. In the published group, the children waited an average of 20 days for a heart; no donor hearts were discarded, and none showed primary graft dysfunction or rejection during the study period, according to Vanderbilt Health’s announcement.

Vanderbilt notes that children, especially newborns and infants, can wait many months for a heart, and that long waits are associated with about 20% waitlist mortality. Still, the findings come from a very small number of patients at a single center and do not yet show long-term survival.

Many organ donors now die after their heart stops, which is known as donation after circulatory death, or DCD. UNOS reports that in 2024, more than 7,200 DCD donors made up 43% of all deceased donors.

Using those hearts has usually meant reanimating them, either inside the donor’s body or on a perfusion machine. Vanderbilt says those approaches can raise ethical concerns in some settings and may be expensive, complex, or limited by patient size. REUP instead flushes the recovered heart with a cold, oxygen-rich solution without restarting it.

Every donor recovery in the pediatric study took place in a setting where reanimating a donor heart was not permitted because of ethical concerns. The investigators said those hearts would not have been available without REUP.

“By adapting the technique for children, we’ve been able to recover donor hearts across all pediatric age groups, including hearts that otherwise would not have been used,” said Dr. Aaron Williams, an assistant professor of cardiac surgery at Vanderbilt Health and the study’s first author.

The first child in the country to receive a heart recovered this way was Aleah “Sissy” Keasling of Newport, Tennessee. She was 9 and living with dilated cardiomyopathy, a genetic disease that weakens the heart muscle over time, when her family got the call on Jan. 3, 2026, according to Vanderbilt.

“I honestly couldn’t have asked for a better outcome,” said her cardiologist, Dr. Caroline West. Vanderbilt said traditional methods can safely preserve donor hearts for about four to five hours, while its surgeons say REUP has preserved hearts for more than 10 hours.

The pediatric work builds on adult results. In a JAMA study described by Vanderbilt in February, 24 adults received REUP-recovered hearts, and one developed severe primary graft dysfunction. The authors said further study is needed to evaluate outcomes and compare REUP with other recovery methods.

MedicalDaily Evidence Check: The pediatric findings come from a five-patient series at one center, reported in the New England Journal of Medicine. All recipients had strong heart function after surgery, and none needed mechanical circulatory support during the study period. The report did not compare REUP with other methods or track long-term survival.

Federal data at OrganDonor.gov show that more than 2,200 children under 18 are on the national transplant waiting list. In 2025, more than 770 children became organ donors, including more than 130 infants under 12 months old. Because body and organ size must match, very small children often receive organs from other children, which keeps the pool of usable hearts narrow.

“This innovative approach is truly transformative for the field of pediatric heart transplantation,” said Dr. Ziv Beckerman, surgical director of pediatric heart transplantation at Monroe Carell and the study’s senior author. He added, “We are planning on helping other programs advance and adopt this technique to hopefully allow saving many more lives.”

Parents of a child on the waitlist can ask their transplant team whether the center accepts DCD hearts and how it recovers them. Travel and housing costs can be a real barrier when the nearest transplant program is far away. Families should talk with a qualified clinician before making any decision about listing or changing centers.

Larger, longer studies will be needed to confirm safety. The early results offer real hope for families waiting on the smallest hearts, but they are a starting point, not proof that REUP will work everywhere.

What did Vanderbilt surgeons announce? Vanderbilt reported that five children, ages 2 days to 14 years, received donor hearts recovered with a method called REUP. Five more children have been treated since.

How is REUP different from other donor heart methods? It flushes a recovered donor heart with a cold, oxygen-rich solution instead of restarting it before transplant. That allows hearts from donors who died after circulatory arrest to be used at hospitals where reanimation is not permitted.

Is REUP proven safe for children? Early results are encouraging, with strong heart function and no rejection seen during the study period. The study involved only five patients at one hospital and did not measure long-term outcomes, so larger studies are still needed.

Who could benefit most? Newborns, infants and young children face some of the longest waits because they need small, size-matched hearts. More usable donor hearts could help shorten those waits.

Can my child’s hospital use REUP now? Vanderbilt is the center reporting these pediatric results. Its surgeons say they plan to help other programs adopt the technique, so families should ask their own transplant team which donor heart methods it uses.

What happens next? Vanderbilt plans to share the method with other centers. More study is needed to compare REUP with existing approaches and track long-term outcomes.