Ex vivo coronary angiographic evaluation of a beating donor heart.

C oronary artery disease in the cardiac transplant population has been identified as a cause of worse long-term outcomes and accelerated graft vasculopathy. Pre-existing double or triple vessel in the donor heart is associated with a 61.5% post-transplant 30-day mortality. 1 Significant angiographic donor heart coronary artery disease is generally considered a contraindication to transplantation. As a result, pretransplant screening for coronary artery disease in the donor population is recommended in male donors >45 years of age and female donors >50 years of age with no cardiovascular risk factors. In the presence of risk factors, the screening age should be reduced by 5 to 10 years. 2 In such marginal donors, invasive coronary angiography is the mainstay of investigation for coronary artery disease, although stress echocardiography has also been used successfully before organ harvesting. 3–5 Failure to perform pretransplant coronary angiographic screening of marginal donor populations may be associated with significant financial ramifications related to retrieval cost if the allograft is subsequently found to be unsuitable for transplant. However, preharvest coronary angiography may not always be feasible because of unavailability of cardiac catheteriza-tion at the donor institution and the need for urgent concurrent intra-abdominal organ procurement. Delay in procuring and transporting donor organs to recipient centers may also increase cold ischemic times, resulting in compromised donor organ viability. 6 The traditional technique for donor heart preservation involves simple hypothermia to reduce the graft organ metabolic rate. 7 Continuous hypothermic perfusion and continuous warm-blood perfusion have been postulated as alternative means of prolonging the transport time of harvested organs and improving clinical outcomes after transplant. Sterile donor graft perfusion, oxygenation, and metabolic homeo-stasis can be maintained continuously within a perfusion box during organ transport and, as a result, the deleterious effects of cold storage may be avoided. 7 The feasibility of warm-blood perfusion box transport of cardiac grafts has been demonstrated, and the effect on clinical outcomes is the subject of ongoing clinical trials evaluating the effectiveness of the organ care perfusion system in the preservation of donor hearts. 8,9 We describe a case of an ex vivo coronary angiography performed on a beating donor heart contained within a sterile warm-blood perfusion chamber when preharvest coronary angiography could not be performed. After brain death resulting from a road traffic accident in an interstate location, a 40-year-old smoker with a strong family history of ischemic heart disease was approved for multiple organ …