Successful Abdominal Organ Donation after Brain Death in a Patient with a Biventricular Assist Device: Extending Extended Criteria

Susanne Carpenter, D. Eric Steidley, David D. Douglas, K. Sudhakar Reddy, David Mulligan, Louis Lanza, Adyr Moss

Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, USA.
Division of Hepatology, Mayo Clinic Arizona, Phoenix, USA.
Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, USA.
Divsion of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, USA.

DOI: 10.4236/ojots.2013.32006                

Abstract

Few studies address the potential for donation after brain death (DBD) in the limited population of patients with ongoing mechanical circulatory support (MCS). A case study was conducted reviewing available records of both donor and recipient, and available literature. The donor was a young female with an acute myocardial infarction precipitating emergent off-pump 2-vessel bypass graft complicated by profound cardiogenic shock refractory to inotropes and intra-aortic balloon pump. A heparin drip was started following percutaneous placement of a left ventricular-assist device (TandemHeart^?) which improved her hemodynamics to stabilize for transfer. She ultimately required surgical placement of biventricular assist device (CentraMag^?) to normalize hemodynamics. Two days post-operatively, she developed a cerebellar hemorrhage and was declared brain dead. Pre-donation blood chemistry showed adequate end-organ function. Both kidneys were placed locally. The liver was rejected for two regional status 1 patients and by all other local centers. We accepted the liver for a patient with polycystic liver disease with a MELD exception score of 20. The recipient is now 4 years post-transplant with excellent graft function. Extending donor criteria to include MCS patients can result in successful transplantation and should be considered in selected circumstances once satisfactory donor end-organ function is established.

Keywords

Extended Criteria Organ Donation; Donation after Cardiac Death; Ventricular Assist Device

Conflicts of Interest

The authors declare no conflicts of interest.

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