This focused issue on “Pediatric Heart Transplantation” is edited by Dr. Justin Godown, from Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA; and Dr. Shawn C. West, from Pediatric Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
Heart transplantation represents the common final pathway for many children with end-stage heart failure and outcomes continue to improve. While significant advances in the field have been realized over the past four decades, many challenges remain. Waitlist mortality for children awaiting heart transplantation remains unacceptably high and children listed for heart transplantation have the highest risk of death among all solid organ transplant candidates. This is compounded by a lack of standardized criteria for donor acceptance and the fact that nearly 50% of pediatric donor hearts are discarded. Increasing use of ventricular assist devices has improved waitlist mortality, but few devices are designed specifically for the pediatric population and supporting small patients or those with congenital heart disease remains problematic.