Case Log 2/8/2024
Mission Profile:
Organ Type: Heart/Lungs
Wheels Up: 1345
Scheduled OR time: 1500EST
Donor Location: Virginia
Recipient Location: New York / Illinois
Aircraft Type: Cessna Citation 560 Encore
Activation:
We knew this case would be going the evening before so that was not a big deal. It was not until I was trying to get ready to leave the house that the scheduling fun began. 2 other cases dropped in our laps with OR times scheduled around the same time. This becomes an issue when the timing is tight and we need to get aircraft mobilized – most companies have a 4 hour call out time. This means they must be given 4 hours heads up before they can have a plane on their way to us.
Flight #1
The flight to Virginia was nice, a little cloudy. Time en route: 57 minutes.
Donor Side:
As our team has seen a few times in the recent past, when we arrived to the hospital we found out that the originally accepting lung center backed out at the last second. We checked over the donor paperwork and saw that the donor lung challenge gas (blood gas readings we take to see how the lungs are functioning) were phenomenal! When we arrived to the donor hospital, we informed the OPO staff that we would be happy to procure the lungs for whatever center could accept them. We cannot, in good conscience, let those lungs go to waste. After several calls to centers on the lung list, there was a center that was willing to accept the lungs. Whew! We got the donor situated, prepped, draped and began the procurement process.
OR Surprises:
We had 2 things working against us during the donor case: 1. The smallest OR I’ve been in for a procurement (and in the Gynecological ORs to boot!) and 2. The liver team was splitting the liver.
A small OR is doable, but this was a REALLY small room. Power outlets were sparse and the floorspace was worse. It was almost to the point of contaminating the sterile field because of how the whole room was set up and how many people were in there.
Complications:
When the liver is split, 2 people’s lives can be saved from the same liver. Win win! The only downside is that it comes at the cost of a few additional hours of time that the donor body is exposed to the air. This is a problem because of heat loss from the donor body.
Your skin and subsequently the layer of fat on your body is like a jacket for your organs. As long as the jacket is closed, the organs remain nice and warm and happy. When we open the jacket (skin and fat layer) a lot of heat escapes the body. To prevent this we use a warming blanket called a Bair Hugger that provides warm air circulating under the drapes of the donor.
The other issue is that because of the nature of surgery, there is some blood loss to the donor as well. This further exacerbates the heat loss issues and also creates a stability issue with the donor. Less blood in the body means less of a margin for blood pressure to stay in an acceptable range.
The organs:
The heart was doing great right out of the gate, no concerns to be mentioned and the heart was accepted. The lungs were not doing so well at first. We started by using a bronchoscope on the patient to take a look at the lungs from the inside, noting that it was nice and clear int here. We exposed the lungs and had the anesthesiologist give some “deep breaths” to help open up the lung more and therefore function better. This caused a LARGE increase in lung function when we checked the blood gasses again, though still not as good as we would like though. We spoke with the accepting surgeon and elected to send them to a 3rd party service that puts the lungs on pump. This would allow the lungs to be rehabbed before being placed in the recipient.
Time to go:
We needed to move quickly, the donor wasn’t doing well. We asked the liver team to speed up their portion of the dissection to make sure that all organs could be recovered before the donor crashed. Remember, we’re performing a MAJOR surgery on a brain dead donor. The body is not meant to be in this state for long. The liver team finished their work quickly and the pancreas team was ready too. We moved forward and all organs were taken to where they were supposed to go. Everyone wins!
Flight #2:
The flight to New York was uneventful, which is good while trying to eat our dinner. The pilots got us food from Longhorn Steakhouse and we all had chicken and shrimp meals. We are always appreciative for a good meal after a long and complicated case. Flight time: 61 Minutes.
Recipient Side:
The recipient side went smoothly. This particular transplant center we were taking the heart to is very close to the airport, which means a shorter ground time there and less stress on the heart. They were ready for the heart, in and out!
Flight #3
The flight home was a pretty rough, the winds were pretty fast on landing leading to what we refer to as the “Short Final Rodeo” – referring to the last phase of flight before landing known as “short final”.
Post Case:
You know the drill, restock the bag, break down boxes, hit the lights, lock the door, take out the trash. Ready for the next one!
