Modification of a biventricular assist device to facilitate preservative infusion and organ recovery in a nonheart-beating donor.
A 46-year-old patient supported by a biventricular assist device (BiVAD) was transferred to our institution for evaluation for heart transplant. The patient was found to have a large intracranial hemorrhage with profound deterioration of neurologic status. The poor prognosis prompted the decision to withdraw care and pursue organ donation. Because the patient did not meet brain death criteria, nonheart-beating donor organ donation was pursued. After the termination of care, the BiVAD was modified: the left side to provide organ preservative solution and the right side to allow drainage. Eight liters of cold University of Wisconsin solution were pumped systemically over 10 minutes, the donor was drained, and the liver was harvested. This technique expedited donor perfusion by eliminating the need to cannulate, minimizing ischemic time for the liver. Although the recipient outcome was poor, and retransplantation was eventually necessary, we believe it was most likely not attributable to the quality of organ preservation. This report discusses the technical aspects of this potentially beneficial procedure.
Angona
Ron
R
Department of Surgery, Division of Cardiothoracic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. ron_angona@urmc.rochester.edu
Abt
Peter
P
Younan
Duraid
D
Massey
Todd
T
Marvin
Michael
M
Kashyap
Randeep
R
Richards
Dan
D
Jones
Karen
K
Queschenbach
James
J
Zand
Martin
M
Jain
Ashok
A
Orloff
Mark
M
Bozorgzadeh
Adel
A
D002102:Cadaver; D006353:Heart-Assist Devices; D006801:Humans; D008099:Liver; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D009927:Tissue and Organ Procurement; D019737:Transplants