Children who require heart surgery should receive treatment in Dublin as opposed to the current facility in Belfast, according to recommendations by the Health and Social Care Board.
The service provided at the Royal Belfast Hospital for Sick Children in Belfast was deemed unsustainable due to the numbers of patients it deals with - around 90 a year.
Last year a UK-wide report said that centres must perform a minimum of 400 children's surgical procedures each year.
Today's recommendations are subject to approval from Health Minister Edwin Poots, who is expected to make a final decision in the next few weeks.
Mr Poots said he intended to hold further discussions with counterparts in the Republic and explore the scope for flexibility in the location for the future delivery of this service without compromising patient safety.
"My key priority in all of this is to ensure the delivery of a safe and sustainable service for these vulnerable children," he said.
"In so doing, I want to ensure that we have fully explored every possibility for addressing the concerns which have been raised with me by parents and by consultants."
Samantha Marshall, whose son Tom aged two has a condition, said: "Four to five children a year will not survive a journey to Dublin."
The board examined options for providing the relatively rare operations, including using hospitals in England as well as Our Lady of Lourdes in Dublin.
Chief executive John Compton said: "It is a fact that uncertainty has hung over those services now for a very protracted period of time, well before the establishment of this organisation.
"It is very important that we get to the point where that uncertainty is removed."
Congenital heart disease is the most common birth defect in Northern Ireland, with around 250 babies born with the condition every year, according to the Children's Heartbeat Trust charity.
Last year an expert report said centres must perform a minimum of 400 children's surgical procedures each year to maintain skills. Belfast falls short of that number, with the volume of cases decreasing in recent times.
The health board's decision followed another review that said, while safe, undertaking heart surgery at the Royal Belfast Hospital for Sick Children was no longer sustainable.
This was primarily because of the small population served and lower activity level of medics than recommended by professional organisations.
Following an investigation, the board decided children who required planned surgery should travel to Dublin, with an improved transport network from Northern Ireland to help meet the three hour timeframe for emergency surgery. Support cardiology services in Northern Ireland will be enhanced.
But Ms Marshall predicted: "The cost will send the (Stormont) Executive into meltdown and in austerity... services will be cut."
Another parent asked the board: "Is it the health minister or the commissioners who will take responsibility when a child dies?"
Options ruled out included splitting surgery between Belfast and Dublin or involving hospitals in Great Britain.
For the past year parents and members of the Heartbeat Trust have campaigned for the retention of children's heart surgery in Northern Ireland.
The trust's minority report was submitted to the board during a meeting punctuated by emotional interjections from concerned parents.
"We do not have confidence that any recommendation that removes all children's heart surgical services from Northern Ireland can meet the necessary criteria of providing a safe and quality service, cater for emergency cases or guarantee the essential maintenance of the specialist medical skills within Northern Ireland that all children with congenital heart disease rely upon," it said.
However, the Republic's health minister Dr James Reilly told the BBC there was no limit to the shared frontiers which could be explored.
"I am quite happy that we will have a capacity here in Dublin to look after children from the North of Ireland," he said.
Ulster Unionist Stormont MLA Robin Swann's son Evan is only weeks old and awaiting treatment for the birth defect. He urged the health minister to change the decision.
"I hope that he has the conviction, that he will take the decision for the people and the parents and the children of Northern Ireland, that he retains cardiac surgery in Belfast," he said.
Belfast health trust, which runs services at the Royal, expressed concerns about retaining surgical skills in Belfast and said the city's cardiologists will have sessions in Dublin.
Patricia Donnelly, director of acute services at the health trust, said: "It has left a lot of people including our staff and families in a situation where they were not clear about the future. To bring that clarity is extremely helpful, we welcome Dublin as the preferred option."