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Modified cardiectomy: documenting sudden cardiac death in hearts selected for valve allograft procurement
Charles V Wetli1, Richard M Kolovich, Lisa Dinhofer
1Office of the Medical Examiner, Center for Forensic Sciences, Suffolk County, Hauppauge, New York 11788-0099, USA. charles.wetili@co.suffolk.ny.us
Insights
Medical examiners can now procure heart valves for transplantation while determining the cause of death. A new dissection technique allows for sterile valve retrieval and post-mortem examination, increasing organ availability.
Area of Science:
- Forensic Pathology
- Transplantation Medicine
- Cardiology
Background:
- Tissue procurement organizations face challenges obtaining heart valves for transplantation.
- Medical examiners often deny requests for heart valves when a cardiac cause of sudden death is suspected, as explantation prevents cause of death determination.
- Current procedures require heart removal for sterile valve procurement off-site, hindering post-mortem examinations.
Observation:
- A novel dissection technique was developed to address the conflict between organ procurement and forensic investigation.
- This technique allows for the retrieval of heart valves under sterile conditions directly within the medical examiner's office.
- The method enables pathologists to document a cardiac cause of sudden death while facilitating valve procurement.
Findings:
- The developed dissection technique successfully increases the availability of heart valves for allograft transplantation.
- It allows for simultaneous determination and documentation of the cause of death by the medical examiner.
- The technique integrates sterile procurement with essential forensic pathology procedures.
Implications:
- This approach can significantly boost the supply of heart valves for transplantation, saving lives.
- It improves interagency collaboration between medical examiners and tissue procurement organizations.
- The technique offers a standardized method for handling cardiac deaths where transplantation is a possibility.
Abstract:
Medical examiners frequently deny requests by tissue procurement organizations for heart valves intended for allograft transplantation. Most of these denials are in cases of sudden apparent natural death, often where a cardiac cause is suspected. The basis of denial in these cases is that the heart must be removed and the valves procured off site under sterile conditions. This prevents the medical examiner from determining and documenting the cause of death. A dissection technique was therefore devised to increase the number of heart valves available for allograft transplantation and to simultaneously allow the pathologist to document a cardiac cause of sudden death. Interagency procedures, the dissection technique, and case summaries are provided.