Case Reports

Modification of a Biventricular Assist Device to Facilitate Preservative Infusion and Organ Recovery in a Nonheart-Beating Donor

^* Department of Surgery, Division of Cardiothoracic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
^† Department of Surgery, Division of Solid Organ Transplantation, University of Rochester School of Medicine and Dentistry, Rochester, New York
^‡ Department of Surgery, Westchester Medical Center, White Plains, New York
^§ Finger Lakes Organ Procurement Organization, Rochester, New York
^¶ Department of Medicine, Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, New York

Address correspondence to: Ron Angona, CCP, Department of Surgery, Division of Cardiothoracic Surgery, Strong Memorial Hospital, 601 Elmwood Avenue, Box 624, Rochester, NY 14642. E-mail: ron_angona@urmc.rochester.edu.

Abstract

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.