King Faisal Specialist Hospital performs region’s first domino heart transplant for two children

King Faisal Specialist Hospital and Research Centre in Riyadh has successfully performed the first operation of its kind in the Middle East and Europe, treating two children using a single donor heart through a sequential pediatric heart transplant technique known as the "domino" procedure.

The operation involved transplanting a donor heart into a 12-year-old boy suffering from end-stage heart failure. Meanwhile, a second child, aged 9, received the pulmonary valve and root taken from the first child's heart after it was removed, as part of a comprehensive treatment sequence.

The hospital explained that the first child had been hospitalized for about six weeks on heart-supporting medication while awaiting a transplant. Although he required a full heart replacement, his pulmonary valve and root remained healthy and suitable for transplantation.

At the same time, the second child underwent a Ross procedure after suffering from severe aortic valve stenosis and insufficiency. His healthy pulmonary valve was moved to replace the damaged aortic valve, and the surgical team reconstructed his pulmonary position using the valve and root taken from the first child's heart.

Domino technique supports growth

The hospital noted that the transplanted valve is living tissue capable of growing with the child, reducing the need for future replacement surgeries, unlike artificial valves that do not adapt to body growth.

Dr. Hani Al-Sarajani, Executive Director of the Heart Center of Excellence, said the procedure is among the rarest forms of partial heart transplantation in children, placing the hospital among a select group of global centers able to perform it thanks to its expertise in heart transplants and complex congenital heart surgeries.

Complex coordination and integrated medical teams

The success of the operation required simultaneous coordination between two complex surgeries and the integration of expertise from heart transplant teams, pediatric cardiac surgery, cardiology, heart failure, cardiac imaging, anesthesia, and critical care, in addition to perfusion, nursing, transplant coordination, and tissue evaluation and preparation.

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King Faisal Specialist Hospital and Research Centre has been ranked first in the Middle East and Africa, and 12th globally among the top 250 academic healthcare institutions worldwide for 2026. It also holds the highest-value healthcare brand in Saudi Arabia and the Middle East according to Brand Finance, and is listed by Newsweek among the world’s best hospitals for 2026.