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

Abstract

Background: Few studies address the potential for donation after brain death (DBD) in the limited population of patients with mechanical circulatory support (MCS). Methods: A case study was conducted reviewing available records of both donor and recipient. Results: The donor was a 47-year-old female smoker who suffered an acute MI. An emergent off-pump 2-vessel CABG was performed but was complicated by profound cardiogenic shock refractory to both inotropic agents and intra-aortic balloon pump. A percutaneously placed LVAD (TandemHeart) improved her hemodynamics but she remained with significant hypotension and depressed cardiac output. She started on heparin infusion. She was transferred to our institution where a surgical biventricular assist device (CentraMag) was placed and hemodynamics normalized. Two days post-operatively she developed an intracranial cerebellar hemorrhage and was declared brain dead. Predonation blood chemistry showed creatinine of 0.7, AST 88, ALT 21, INR 1.46, and pH of 7.33 and paO2 85.3. She was consented for organ donation. Both kidneys were placed locally. The liver was turned down for two regional status 1 patients and by all other local centers. We accepted the liver for a 44 year old patient with massively enlarged liver due to polycystic liver disease with a MELD exception score of 20. The peri-operative course was uneventful and the recipient is now almost 4 years post-transplant with excellent graft function. Conclusion: 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.