Donor Operation in Heart Transplantation

Donor cardiectomy is the first-step operation of heart transplantation. Despite the importance of the procedure, donor operation is scarcely observed by cardiothoracic surgical trainees. The authors present a donor cardiectomy video with step-by-step comments for educational purposes. In this particular case, the operation was performed by the heart, liver, and pancreas procurement teams.

The first step of a donor operation is reviewing all the relevant medical records and available resources of the donor hospital, including surgical instruments. Upon arriving at the donor’s operating room, the procurement surgeon must recheck the donor’s condition, which sometimes changes abruptly. Throughout the whole procedure, the procurement team must communicate with the recipient operation team in real time to orchestrate the successful heart transplantation.

After paying a silent tribute to the organ donor and their loved ones, a generous median sternotomy is performed. The midline incision is usually continued to the median laparotomy by the abdominal organ procurement teams. The sternal retractor is placed upside down so it does not interfere with the abdominal operation field by the crossbar. The heart dissection procedure is performed as demonstrated in the video clip.

When the donor cardiectomy is performed, it is of paramount importance to interact with other organ procurement teams. Especially in the case of concomitant pulmonary and/or hepatic procurement, the following issues must be discussed in detail: the incision lines between the pulmonary veins and the left atrium, the pulmonary trunk transection level, and the inferior vena cava transection level. In this process, adequate communication and polite and considerate attitudes are strongly encouraged. Once the heart is emptied and arrested with cardioplegia, the tissue becomes very elastic, which makes it hard to determine the exact amount of tissue even with a subtle retraction. The authors, therefore, prefer to use surgical marker pens to mark the agreed incision lines with other procurement teams before cutting the vessels and the left atrium, which is clear and easy to communicate.

This video describes the routines of cardiac donor operation by the heart procurement team of the Asan Medical Center in Seoul, Korea, where the authors were trained. The authors hope that this video is helpful to the trainees along with other excellent references (1-3).

References

1. Khonsari S, Sintek C, Ardehali A. Cardiac Surgery: Safeguards and Pitfalls in Operative Technique: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008. 186-188.
2. Camp PC, Jr. Heart transplantation: donor operation for heart and lung transplantation. Op Tech Thorac Cardiovasc Surg. 2010;15(2):125-137.
3. Copeland H, Hayanga JWA, Neyrinck A, MacDonald P, Dellgren G, Bertolotti A, et al. Donor Heart and Lung Procurement: A Consensus Statement. J Heart Lung Transplantation. 2020;39(6):501-517.

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