Austin, Texas-based Dell Children’s Medical Center went from performing its first pediatric heart transplant in 2020 to becoming a top 10 nationally ranked program in only five years.
Before starting the program, pediatric patients had to go to Dallas or Houston to receive advanced heart care.
Leaders at Dell Children’s Medical Center — the region’s only comprehensive children’s hospital and pediatric Level I trauma center — made the decision to invest in complex care service lines so children would no longer have to leave the city for care, Adam Messer, president of Dell Children’s Medical Center, told Becker’s.
That guiding principle, along with a collaboration with Dell Medical School at The University of Texas at Austin and Ascension, led to the creation and expansion of the heart transplant program.
Building the program
The journey began in 2018 when Charles Fraser Jr., MD, joined Dell Children’s Medical Center as chief of pediatric and congenital heart surgery and chair of the department Cardiovascular and thoracic surgery at the University of Texas, Dell Medical School.
“We started with zero,” Dr. Fraser told Becker’s. “There were community cardiologists here who were well established and working hard for a for-profit corporation, but beyond that, there was completely itinerant service. When word got out that I was coming and there was a coalescence of forces: a new medical school, a developing hospital with an exciting vision, a system that believed in the ideal, a rapidly growing population, an enthusiastic community.”
Ascension, Dell Children’s and the University of Texas medical school came together to create a unified vision to have a focused, dedicated, integrated heart transplant program. Then they created a steering committee made up of the chiefs of every major department in the heart center, along with representatives from the university. The committee meets every Tuesday. It started as an operational necessity, but now, “it’s like the Supreme Court of the heart center,” Dr. Fraser said.
“We don’t hire new positions except through that committee,” he said. “We don’t make major programmatic or strategic decisions except through that committee. Everyone is enfranchised. That’s an operational commitment and vision we have really embraced.”
With the steering committee in place, the leaders began the operational and clinical development that makes the foundations of a transplant program. This included developing ambulatory care facilities, clinical spaces and creating a 48-bed intensive care unit and step-down unit.
Hiring clinicians to staff the program was easier than they anticipated, Dr. Fraser said. Clinicians and leaders were excited to be part of the new opportunity and help build the program.
“It’s actually harder in some ways to recruit top talent into a program that is already well established and consistently high-performing,” Mr. Messer said. “A different kind of physician comes to a place that is still being built — someone who wants to be a builder, who wants to realize that they’re not just joining something great, but helping to create it.”
The hospital still faced some difficulty attracting anesthesiologists, critical care physicians and subspecialties within cardiology.
“Building a program is like filling out a major league baseball team,” he added. “You need the right role players, and some of them come from very rare training pathways.”
From there the program took off. Patients began arriving with end-stage, serious cardiac illnesses and the heart center leaders had to decide “whether we were going to turn them away or step up and take care of them — which meant mechanical circulatory support, not just ECMO but durable mechanical circulatory support,” Dr. Fraser said. “And if you’re going to offer durable mechanical circulatory support, you have to offer transplant. So that’s what happened, and it happened fast.”
The results
When Dr. Fraser did his first rotation at Dell Children’s back in June 2018, there was one cardiac patient in the building. On March 26, 2026, there were 48 cardiac patients, with 10 patients waiting for a heart transplant.
“The program exploded,” Dr. Fraser said. “I think most of us here underestimated how busy and complicated this program would become and how rapidly.”
The program implanted its first LVAD in 2019, performed its first pediatric heart transplant in 2020, performed Texas’s first pediatric partial heart transplant and became one of the few doing this procedure around the globe, and in 2025, became a top 10 pediatric cardiology and heart surgery program in U.S. News & World Report.
The program has consistently performed about 10 heart transplants per year since opening, and hit its 50th heart transplant milestone in February.
The evolution of the heart program has pushed a rise in case mix index, complexity of care and become a tent pole for the hospital ecosystem, Mr. Messer said.
“Cardiac has been the catalyst for bringing many Central Texas firsts to Austin over the last decade,” he said. “It has elevated our profile, elevated our ability to care for complex disease, and in doing so, it has become the flywheel of sustainability — creating financial impact that allows the institution to invest in things that would otherwise be very difficult to sustain on their own.”
The future
The center is now entering its “Heart Center 2.0” phase, Mr. Messer said, which focuses on expanding services.
This means asking “how far have we come, and what will it take to get to the next level?” Mr. Messer said. “In many ways, the answer isn’t more cardiologists or more surgeons. It’s the specialists that draw families in from other regions. You go from a program focused on keeping kids in Austin, to a program that people are traveling to Austin for. That’s the 2.0 flip.”
This means continuing to perfect what has already started as well as adding new services, including donation after circulatory death and opening new transplant programs. The hospital recently started a bone marrow transplant program, and is aiming to start offering kidney and liver transplantation.
“I think it’s incumbent on centers embedded in major public research universities to push the frontiers of treatment for heart failure — not just transplant, but all elements of heart failure care,” Dr. Fraser said. “We will have our place in that continuum of contribution, and that drives real clinical improvement opportunities. There’s a lot of hard work ahead, but that’s part of the scope of the opportunity here, and it’s very exciting.”
Want to build a top tier transplant program?
Systems across the nation are starting up heart transplant programs, and many are in their first few years of operation. For programs at the beginning of their journey, Dr. Fraser has two pieces of advice.
1. “Jumping into a transplant program is not for the timid. There has to be staying power and unified belief at every level — the hospital, the system, all the elements of the engine — because you will have good days and hard days, and the hard days can be very real. The enterprise has to be unified. You can’t dabble in this. You have to be all in, and you have to stay the course, because this is a never-ending journey. It’s not a destination.”
2. “I think you have to ask honestly: are you compromising at any level in terms of system support or personnel? And you have to be brutally honest — internally and publicly — about any real or perceived deficiencies, and show that you are actively working on them. That’s where focus and persistence are mandatory, because it’s hard. But if the need is there, and patients are arriving from every direction, it’s very difficult to turn away from that responsibility.”
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
