Infant heart transplantation: a survey of physician beliefs.

Heart transplantation in infancy has become the fastest growing area in pediatric heart transplantation. Infant heart transplantation presents a profoundly complex decision-making situation for parents. There is a relationship between physician beliefs and their manner of presenting heart transplantation options to parents. The purpose of this study was (1) to determine the beliefs of physicians about neonatal heart transplantation, (2) to define their perceptions about their role in counseling parents about heart transplantation, and (3) to evaluate the differences of beliefs by physician specialties (pediatric cardiologists, neonatologists, and pediatricians) and practice settings (university, private, health maintenance organization). A questionnaire was designed to survey 117 physicians on their beliefs about heart transplantation. Findings revealed significant differences related to beliefs: (1) infant heart transplantation is still experimental (pediatric cardiologists, 56%; neonatologists, 85%; pediatricians, 63%; p < 0.05), (2) neonatal heart transplantation is acceptable for fatal heart disease (pediatric cardiologists, 86%; neonatologists, 73%; pediatricians, 63%; p < 0.05), (3) newborn heart transplantation should be presented negatively to protect parents from potential negative consequences on their quality of life (pediatric cardiologists, 14%; neonatologists, 33%; pediatricians, 48%; p < 0.05); (university, 25%; private, 18%; health maintenance organization, 61%; p < 0.05), and (4) infants with hypoplastic left heart syndrome should not be treated (university, 28%; private, 23%; health maintenance organization, 55%; p < 0.05). Though it is critical to impart information to parents with a fair representation of infant heart transplantation, we conclude that many physicians surveyed had a knowledge deficit or bias about the current state of the art of infant heart transplantation.