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OneLegacy Status 1A cases
Aaron Cohen Manager of Donor Allocation OneLegacy
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Case 1 Demographics Medical History:
5’10”, 193 lbs. COD: MVA, driver struck the back of another vehicle. Medical History: Consumed 24 pack of beer every weekend last 10 years per family
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Lab Panel
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ABG’s
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Donor Work up Moderate bilateral perihilar and basilar lung consolidation noted, right greater than left, consistent with bilateral pneumonia or adult respiratory distress syndrome, or pulmonary contusion. The degree of lung consolidation appears worse in comparison to earlier examination. CXR
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Other factors Family gave no time constraints and was eager to donate all organs 24 hours case time elapsed Family Trauma center Difficult to schedule and keep a solid OR time at this facility Hospital One of 5 active donors being managed that day Difficult to maintain coverage for all the cases Staffing
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Urgent Request PTR made anahepatic due to transplant 10 days ago PNF
Local Liver Center Urgent Request Clinical, Allocation and Administrative management huddled and identified this case as possibility to rush Internal conference call Lungs – No offers made yet, deemed unlikely for transplant due to contusions. Heart – No offers made yet. Administrative decision to rush case to OR in order to recover liver for Urgent Status 1A Cessation of Allocation efforts
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Outcome Kidney Pancreas Intestine Heart Lung Liver
Not Recovered due to rushed case Lung Liver Recovered and transplanted into Status 1A Kidney Both recovered and transplanted Pancreas Evaluated in OR and declined Intestine Declined nationally
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Liver outcome PTR Status - Dead
Liver was transplanted successfully, but PTR died days later due to complications. PTR Status - Dead
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Case 2 Demographics Medical History: 1 month post partum
39/F 5’2”, 161 lbs. COD: SAH s/p admit to hospital for headache nausea, vomiting Medical History: 1 month post partum Severe headaches x3 weekly last 5 years DVT in right leg 2-3 year ago
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Lab Panel
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ABG’s
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Other factors Family was eager to get the process over with
48 houts case time elapsed Family Regional hospital OR setting can be difficult as they are not willing to call in a surgical team on off hours very often Hospital One of 3 active donors being managed that day Adequate staffing to manage all donors Staffing
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Urgent Request PTR made anahepatic due to previous transplant PNF
Local Liver Center Urgent Request Clinical, Allocation and Administrative management huddled and identified this case as possibility to rush Internal conference call Lungs – Offers in progress. Heart – Already placed at the time of Urgent Request Allocation
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Outcome Kidney Pancreas Intestine Both recovered and transplanted
Heart Recovered and Transplanted Lung Bilateral Lungs recovered and Transplanted One Lung PTR was bypassed due to need for Crossmatches, next local center accepted 4 hour prior to scheduled OR Liver Recovered and transplanted into Status 1A Kidney Both recovered and transplanted Pancreas Evaluated in OR and declined Intestine Declined nationally
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Liver outcome PTR Status - Alive
Liver was transplanted the PTR is currently alive and thriving. Liver and Left Kidney transplanted. PTR Status - Alive
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Questions
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