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Waiting Before Birth: Outcomes After Fetal Listing for Heart Transplantation

Following fetal diagnosis of a profound heart defect, transplantation (HTx) is an alternative to pregnancy termination or neonatal surgical palliation. Retrospective review of the cardiac and transplant databases of fetal listings for HTx between 1990 and July 2006 was undertaken to describe outcomes after listing. We identified 26 fetal listings (of 269 total listings). Diagnoses included congenital heart disease (n = 24) and cardiomyopathy (n = 2). Seven patients were delisted after birth: in five cases parents opted for surgical palliation, two clinically improved. One patient died wait‐listed (stillborn). Time wait‐listed as a fetus ranged from 1–41 days (median 19 days). Eighteen patients underwent HTx (median weight 2.8 kg, range 2.1–10.9 kg); median days wait‐listed after birth was 22 (4 h–123 days). Two fetuses were surgically delivered at 36 weeks gestation when a donor organ became available; 11 were transplanted as neonates (<30 days). The median age at HTx was 1 month (4 h–2.6 months). Fetal listing for HTx increases the potential window of opportunity for a donor organ to become available; patients had low wait‐list mortality and a fair intermediate‐term outcome. Well‐defined criteria for eligibility for fetal listing and priority allocation to infants over fetuses seem rational approaches for centers that offer fetal listing.