Page 18 - ANZCP GAZETTE DECEMBER 2023

HEART TRANSPLANTATION: THINKING INSIDE THE BOX
Amber Darwinkel-Wodson
The Alfred, Victoria
The Royal Children’s Hospital, Victoria
Join me for a donor heart procurement utilising the XVIVO Heart Box! This is an amalgamation of stories I’ve collected on my journey through the HOPE/NIHP trial.
19:00
It’s a Friday night with a glass of wine on the couch and the Severance season finale... and the phone rings. Uh oh, it’s the transplant coordinator. We have a potential heart transplant in the morning! Do we have the perfusion staff for an XVIVO Heart Box retrieval? Do we have enough stock of disposables and drugs? Don’t get too excited, we still need a recipient cross-match and to do some donor imaging – hang tight and she’ll confirm. You spend the next hour on the phone putting feelers out to the team, “I know you’re not on call, but...”
Okay, so we’ve sorted perfusion staff, now to figure out XVIVO disposables. Oh no, we used the last of the stock for the retrieval last week, let’s call our friends at The Alfred and send a staff member over to collect (not sure why taxi drivers aren’t happy to sign out cocaine- containing heart supplement on our behalf...?)
20:00
Another phone call from the coordinator, we have the green light! Itinerary has been set, the team is due to leave the hospital at 2am which means you should arrive at midnight to allow plenty of time to organise drugs, blood and prime the box. Time for a catnap before a long night...
23:00
Despite your best attempts to request sleep, you field another two phone calls.
00:00
Just as you doze into a proper sleep cycle your alarm rouses you, feeling not quite rested but alas. Bleary-eyed, you arrive at the hospital ready to dive into work – but first, coffee. Turns out your afternoon staff stayed late to organise all your drugs (why is it always difficult to track down the meropenem?), one quick trip to blood bank for a unit of red cells and you’re ready. Switch on the box so it can start cooling to 8°C, seat the circuit and connect all the monitoring. Five bags of XVIVO preservation fluid to mix up with heart supplement solution and a cocktail
of other drugs. Fairly straight forward, you just follow the recipe. You spike the first three bags for the prime, as well as the unit of red cells – the one unavoidable variable that will have you manually calculating your buffer and potassium. Let it circulate, de-air the circuit and pressure test the system for leaks. Set a fifteen-minute timer, and now we wait. Second coffee? Seems like a good time to clean your mess (wow, you really did hurricane through this pump room), and package up the last two preservation fluid bags on ice in an esky for transport. Time to check the XVIVO backpack for cannula and spare carbogen cylinders, but of course it’s been diligently restocked after the last procurement.
01:15
Wow, is that the time already? You take a sample of the prime and check the pH and potassium. You manually calculate your additives, thanking your lucky (and fatigued) stars that the improved bicarb formula is spot on and you can avoid the additional 20minutes to recirculate and re-test.
02:00
Procurement team assemble! You’ve collected a couple of surgeons, a plethora of equipment, an esky and a heart box. Let’s go!
15 DECEMBER 2023 | www.anzcp.org