Donor heart injury caused by liver needle biopsy during multi-organ procurement surgery: A case report

Thoracic organ procurement procedures have been standardized for decades, and serious organ injury during procurement is considered rare. However, when injuries do occur, they may result in irreversible loss of transplantable organs.

We report a rare case of unintentional donor heart injury caused by transdiaphragmatic liver core needle biopsy using a Tru-Cut-type device during multi-organ procurement. Two puncture injuries were identified on the inferior wall of the heart adjacent to the posterior descending coronary artery. Although there was no active bleeding and gross ventricular function appeared preserved, the proximity to a coronary branch raised concern for potential coronary injury and re-bleeding following systemic heparinization. After multidisciplinary discussion among the cardiac procurement team, recipient transplant team, and the organ procurement organization, the donor heart was declined intraoperatively.

This case highlights a preventable mechanism of procurement-related cardiac injury and underscores the importance of coordination, timing, and situational awareness among procurement teams to minimize avoidable donor organ loss.