Heart Transplant Donor Retrieval Protocol

Operative Steps

Upon Arrival

1. Call transplant center to indicate arrival at the site of donor harvest.
   
2. Ascertain the organs to be taken and specific plans for each donor retrieval team.
   
3. Assess patient's hemodynamic status. If necessary, optimize hemodynamic status by volume loading and weaning beta adrenergic pressers and beginning alpha agents to maintain perfusion.
   
4. Review ECG, echo, coronary angiograms, antibody status (i.e. HIV, Hep B, C, CMV, EBV)
   
5. Confirm blood type
   

Operative assessment

1. Perform sternotomy, and create a pericardial cradle with sutures.
   
2. Feel Ao, PA, LA, RA for thrills
   
3. Examine the heart for wall motion, scars and contusions
   
4. Palpate and observe the coronary arteries for atherosclerosis
   
5. Dissect out Ao and PA, IVC, SVC
   
6. Place a silk tie around the SVC
   

Confirmatory phone call

1. Notify the transplant center if the heart is acceptable.
   
2. Give an estimate of cross clamp time and travel time to allow planning to minimize ischemic time, particularly if prolonged perparation is necessary in the case of a reoperation or previously placed LVAD.
   

Organ recovery

1. Scrub prior to cannulation and ligation of the aorta and IVC by the liver/kidney team.
   
2. Ascertain if the liver/kidney team plans to vent into the pericardium or through the infrarenal IVC.
   
3. Administer 30,000 U Heparin intravenously
   
4. Suture securely in place the cardioplegia cannula, and attach clamped perfusion line.
   
   • Generally the initiation of the clamping and perfusion sequence is initiated by the cardiac or pulmonary team.
   • Tie SVC
   • Clamp IVC if the liver team vents through the infrarenal IVC.
   • Clamp Aorta
   • Infuse 1 liter of cardioplegia
   • Hemisect the IVC anteriorly to vent the right heart.
   • Cut left superior pulmonary vein or if the lungs are being harvested the left atrial appendage to vent the left heart.
   • Submerge the heart in slush solution
   • Place a sucker in the IVC to collect warm effluent, if it is open.
     
5. Watch closely for inadequate venting and RV or LV distension, particulary if the lungs are being harvested, as the lung perfusate will return to the left atrium which must be adequately vented.
   
6. Once the cardioplegia is completed excise the heart
   
   • Divide the aorta at the arch
   • Divide the IVC flush with the pericardium
   • Divide the pulmonary veins flush with the pericardium unless the lungs are being taken then leave a small cuff of atrium attached to the veins.
   • Divide the main PA at the bifurcation.
     
7. Inspect the valves for defects and vegetations
   
8. Check for the presence of a patent foramen ovale
   
9. Insure there is an adequate rim of atrial tissue next to the coronary sinus
   
10. Pack in iced cardiplegia.

Tips & Pitfalls

• Make sure the liver/kidney and pulmonary teams do not start their infusion of perfusate until the heart is adequately vented
• Avoid RV and LV distension
• Avoid damaging the coronary sinus
• Avoid damaging the SA node.
• Leave the cardioplegia cannula in place for use at time of implantation.