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

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

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.

Highlights

The demand for suitable transplant organs exceeds the available supply both in the United States and throughout the world
This study reports the procurement of liver and kidneys as a donation after brain death from a donor who suffered acute cardiogenic shock, was maintained on continuous flow bilateral ventricular assist device (BiVAD) support, and suffered a hemorrhagic cerebrovascular accident (CVA) which precipitated brain death
She was placed on heparin infusion. She was transferred to our institution where a surgical biventricular assist device (CentraMag®, Thoratec Corporation, Pleasanton, CA) was placed using cardiopulmonary bypass with cannulation on from right ventricle to pulmonary artery and from left ventricle to aorta

Summary

Introduction

The demand for suitable transplant organs exceeds the available supply both in the United States and throughout the world. With the growth of transplant waitlists, criteria for organ donation are being extended to include older and more ill donors [1]. Cardiac and cardio-pulmonary mechanical circulatory support systems including extracorporeal membrane oxygenation (ECMO) and various ventricular assist devices (VADs) are increasingly employed in the United States to support critically ill patients to restore end-organ function during cardiogenic shock [3]. While the last ten years have seen substantial advances in the field, mechanical circulatory support (MCS) systems are still fraught with potential complications like hemorrhagic and embolic cerebrovascular accidents, driveline infections, component failure, and long-term end-organ dysfunction [4,5]. At least one donation has been reported from a patient who was undergoing outpatient VAD bridge-to-transplant therapy and became a donor candidate following presentation with acute cerebrovascular accident (CVA) and brain death [8]. Many centers have performed procurements of this nature with patients as a donation after cardiac death (DCD) which have gone

Methods

Results

Conclusion