Current availability and status of paediatric cardiac transplantation and mechanical circulatory support in twenty-eight European countries

We sought to investigate the inter- and intra-country variation in paediatric heart transplantation (HTx) and mechanical circulatory support (MCS) availability and practice in Europe. Data was obtained through a survey circulated to paediatric transplant cardiologists identified through the Association of European Paediatric and Congenital Cardiology between November 2022 and March 2023. Twenty-eight respondents from twenty-eight European countries completed the survey. Twenty-four (86%) had paediatric and 25 (89%) had adult congenital HTx services. National paediatric HTx centre density ranged from 0.00 to 5.35 per 10 million inhabitants. Eighteen (64%) countries followed either Eurotransplant or Scandiatransplant protocols for organ allocation and 59% of the surveyed countries had low HTx volumes (< 4 paediatric HTx annually), based on the self-reported numbers. A ventricular assist device (VAD) programme was operational in 22 (79%) countries. In only 9 countries (38%), there were dedicated resources for HTx as part of the hospital budget; however, a vast majority (77%) reported that families suffered no cost when a VAD was utilised. Twenty-one countries (78%) reported limited intensive care unit beds and 14 (54%) reported that HTx impacted on congenital heart surgery cases. Only 12 of 27 countries (44%) had a standardised national protocol for post-HTx care. There was no correlation between paediatric HTx centre density, population or GDP per capita. CONCLUSION: There is a high degree of variation both within and between the surveyed European countries with regard to paediatric HTx centre density, VAD availability, listing protocols, and post-HTx management. Multiple factors contribute to this heterogeneity, which makes standardisation of HTx listing and VAD criteria challenging. Increased cross-national collaborative efforts between European countries may strengthen both HTx and MCS availability and outcomes, especially in regions with several smaller neighbouring countries. WHAT IS KNOWN: • The care of paediatric heart transplant (HTx) and mechanical support (MCS) patients varies across Europe. WHAT IS NEW: • This paper elucidates the differences in transplant service organisation and the care of transplant and MCS patients in twenty-eight European countries. • These findings could potentially encourage broader open dialogue and facilitate collaboration across European paediatric HTx centres with development of standardised listing criteria, improved collective European registry data and creation of standards for screening post-HTx patients.

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Publication Details

Journal
European Journal of Pediatrics
Published
2026-04-15
DOI
https://doi.org/10.1007/s00431-026-06927-1
Primary Topic
Transplantation: Methods and Outcomes
Type
article
Field-Weighted Citation Impact
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article

Current availability and status of paediatric cardiac transplantation and mechanical circulatory support in twenty-eight European countries

Ingūna Lubaua, Taisto Sarkola, Bohdan Maruszewski, Sigurdur S. Stephensen et al.
European Journal of Pediatrics
Transplantation: Methods and Outcomes
article

Current availability and status of paediatric cardiac transplantation and mechanical circulatory support in twenty-eight European countries

Ingūna Lubaua, Taisto Sarkola, Bohdan Maruszewski, Sigurdur S. Stephensen, László Ablonczy, Mirko Topalović, Milind Chaudhari, Karin Tran‐Lundmark, José Fragata, Esme Dunne, Johan Van Cleemput, Oscar van der Have, Christian Balmer, Michiel Dalinghaus, Jacob Simmonds, Julie Wacker, Ina Michel‐Behnke, Dorotea Šijak, Karel Koubský, Zdenka Reinhardt, Martin Zahorec, Klaus Juul, Damien Bonnet, Vl Vida, Iolanda Muntean, Zulal Ulger, Colin J. McMahon, Thomas Möller, Annemarie Krauss, Senka Mesihovic-Dinarevic
article en

Abstract

We sought to investigate the inter- and intra-country variation in paediatric heart transplantation (HTx) and mechanical circulatory support (MCS) availability and practice in Europe. Data was obtained through a survey circulated to paediatric transplant cardiologists identified through the Association of European Paediatric and Congenital Cardiology between November 2022 and March 2023. Twenty-eight respondents from twenty-eight European countries completed the survey. Twenty-four (86%) had paediatric and 25 (89%) had adult congenital HTx services. National paediatric HTx centre density ranged from 0.00 to 5.35 per 10 million inhabitants. Eighteen (64%) countries followed either Eurotransplant or Scandiatransplant protocols for organ allocation and 59% of the surveyed countries had low HTx volumes (< 4 paediatric HTx annually), based on the self-reported numbers. A ventricular assist device (VAD) programme was operational in 22 (79%) countries. In only 9 countries (38%), there were dedicated resources for HTx as part of the hospital budget; however, a vast majority (77%) reported that families suffered no cost when a VAD was utilised. Twenty-one countries (78%) reported limited intensive care unit beds and 14 (54%) reported that HTx impacted on congenital heart surgery cases. Only 12 of 27 countries (44%) had a standardised national protocol for post-HTx care. There was no correlation between paediatric HTx centre density, population or GDP per capita. CONCLUSION: There is a high degree of variation both within and between the surveyed European countries with regard to paediatric HTx centre density, VAD availability, listing protocols, and post-HTx management. Multiple factors contribute to this heterogeneity, which makes standardisation of HTx listing and VAD criteria challenging. Increased cross-national collaborative efforts between European countries may strengthen both HTx and MCS availability and outcomes, especially in regions with several smaller neighbouring countries. WHAT IS KNOWN: • The care of paediatric heart transplant (HTx) and mechanical support (MCS) patients varies across Europe. WHAT IS NEW: • This paper elucidates the differences in transplant service organisation and the care of transplant and MCS patients in twenty-eight European countries. • These findings could potentially encourage broader open dialogue and facilitate collaboration across European paediatric HTx centres with development of standardised listing criteria, improved collective European registry data and creation of standards for screening post-HTx patients.

European Journal of PediatricsVol. 185(5)
University College Dublin (IE), Oslo University Hospital (NO), Hôpital Necker-Enfants Malades (FR), University of Helsinki (FI), University of Padua (IT), University Hospital Centre Zagreb (HR), Lund University (SE), Université Paris Cité (FR), Charles University (CZ), Great Ormond Street Hospital (GB), Helsinki University Hospital (FI), Ljubljana University Medical Centre (SI), Freeman Hospital (GB), Copenhagen University Hospital (DK), Rigshospitalet (DK), Children's Health Ireland at Crumlin (IE), Gottsegen National Cardiovascular Center (HU), Universitatea de Medicină, Farmacie, Științe și Tehnologie „George Emil Palade” din Târgu Mureș (RO), Academy of Sciences and Arts of Bosnia and Herzegovina (BA), Ege University (TR), Helsinki Children's Hospital (FI), Assistance Publique – Hôpitaux de Paris (FR), University Hospital in Motol (CZ), Deutsches Herzzentrum der Charité (DE), University Hospital of Geneva (CH), National University Hospital of Iceland (IS), Children's Memorial Health Institute (PL), Riga Stradiņš University (LV), University Children's Hospital Zurich (CH), Skåne University Hospital (SE), Erasmus MC - Sophia Children’s Hospital (NL), Hospital de Santa Marta (PT), Birmingham Women’s and Children’s NHS Foundation Trust (GB), University College London (GB), Geneva College (US), Comenius University Bratislava (SK), Medical University of Vienna (AT), KU Leuven (BE)
University College Dublin
Partnerships for the goals
Openalex Percentile: Top 24%
Transplantation: Methods and Outcomes
DOIOpen Access PDFOpenAlex
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