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Multi-Institutional Collaboration Delivers Neonate Domino Transplant

November 02, 2023

The neonatal team at Orlando Health Winnie Palmer Hospital for Women and Babies initiated a landmark collaboration resulting in the nation’s first multi-institutional neonate domino transplant. The groundbreaking infant heart and subsequent valve transplants included partnering with Orlando Health Arnold Palmer Hospital for Children and the pediatric transplant team at Duke University Medical Center in Durham, North Carolina.

Michael R. Gomez, MD
Michael R. Gomez, MD

“In July, one of our NICU families asked if they could pursue organ donation for their baby,” says Michael R. Gomez, MD, medical director of the Neonatal Intensive Care Unit at Orlando Health Winnie Palmer Hospital. “The baby met the criteria, but it was complicated.”

The Orlando Health teams reached out to Our Legacy, an organ procurement organization in Orlando. Once they found a transplant recipient in North Carolina, Orlando Health integrated its NICU, pediatric intensive care and palliative care teams, and its bioethics committee to help coordinate the process with Duke’s medical team.

After procurement in Orlando, normothermic perfusion was reestablished to maintain the heart’s circulation, temperature and function, limiting the impact of ischemic time during transportation to North Carolina. The first transplant recipient received the new heart. That patient’s valves and aortic arch tissue were then transplanted into another young patient, creating the domino effect.

With nearly 14,000 deliveries annually, Orlando Health Winnie Palmer has one of the country’s most experienced labor and delivery teams. It is Magnet designated for nursing excellence and high-quality patient care and has the fourth-largest neonatal intensive care unit in the United States.

 “We see a lot of complex patients and complicated births,” says Dr. Gomez. “We know how to quickly pivot and redirect care. As a non-transplant center, we had to coordinate across multiple teams, committees and institutions very quickly to find a recipient and initiate the process.”

Cooperation and procedural trust by all partners were key to the success of the high-pressure breakthrough process. “The right doctors at the right hospital teamed with the right partners and ended up with the right result,” Dr. Gomez says. “We are grateful we could play a part.”

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