Two donor hearts beat in one chest

We present the case of a 52-year-old man who had end-stage dilated cardiomyopathy (left ventricular ejection fraction, 0.14) and type-A blood. He underwent orthotopic transplantation with a heart from a blood-type-A male donor on 18 January 2001. After transplantation, the patient could not be weaned from cardiopulmonary bypass. Due to calcification of the left main and right coronary arteries, we performed triple coronary artery bypass (left anterior descending, circumflex, and right coronary arteries) with the recipient's saphenous vein. Despite high doses of inotropic agents and intra-aortic balloon pumping, the patient could not be weaned from cardiopulmonary bypass; he was put on extracorporeal membrane oxygenation 2 hours later. Meanwhile, there was another donor (a woman with type-O blood), who weighed 48 kg. Upon harvesting that heart for a recipient who weighed 68 kg, we found a laceration of the right ventricle. Therefore, we decided to use this marginal donor heart to rescue the graft-failure transplant by means of heterotopic heart transplantation. We left the 1st donor heart in situ. The postoperative series of endomyocardial biopsies showed variations between the 2 donor hearts in degrees of mild-to-moderate rejection. During the 6-year, 2-month follow-up period, the patient has fared well with 2 donor hearts, which beat independently but in conjunction. We conclude that heterotopic transplantation of a marginal donor heart can save an otherwise-dying orthotopic transplant recipient.