Serial echocardiograms, or echoes, can provide valuable insights into a donor heart’s recovery potential, enabling better decision-making that can make an otherwise unlikely transplant possible. While it’s not always easy to get all stakeholders on board with repeat testing, the value of serial echoes in guiding organ procurement decisions is undeniable.
This case study shared by Live On Nebraska Chief Medical Officer Dr. Lee Morrow highlights the benefits of performing serial echoes on a potential organ donor and the importance of advocating for comprehensive data to make informed decisions.
Evaluating Donor Potential
This case involves a woman in her 30s with a history of opioid and amphetamine abuse. She was found unresponsive in a hotel room and transported to a rural hospital in a town of approximately 23,000 people. The facility had limited resources, operating at about half its 100-bed capacity. Upon admission, imaging revealed an intracranial hemorrhage with evidence of brain herniation. The hospital did not have a neurologist on-site. A teleneurologist confirmed the likelihood of brain death, and she was declared brain dead after 24 hours. Notably, the patient was a registered organ donor.
Live On Nebraska took on the case as a potential heart, lung, liver and kidney donor, instituting routine donor management. In a minimally detailed report provided by the on-site cardiologist, an initial echo performed 12 hours post-admission revealed severe hypokinesis, with a poor left ventricle ejection fraction (LVEF) of 10-20%. The only other details provided by the hospital cardiologist were that the left ventricle anatomy appeared normal, there were normal-appearing valves and a likely dilated inferior vena cava (IVC).
Overcoming Resistance to Serial Echoes
Considering this was a young, relatively healthy woman, though with a history of drug abuse, the OPO team recognized the value serial echoes could provide by monitoring cardiac recovery and clarifying the donor heart’s viability. However, the team initially faced resistance from hospital staff when they tried to move forward with additional testing.
“We pushed to get a repeat echo at 24 hours, and they said, ‘Well, no, you don’t need a repeat echo. You just did one at 12 hours,’” says Dr. Morrow. “There was a bit of back and forth, and it had to be escalated to me, in my role as the chief medical officer at Live On Nebraska, and the chief medical officer of the hospital to ultimately get our testing done.”
For more on serial echoes and donor management, check out our blog “How Serial Echoes Can Help Increase the Pool of Viable Hearts for Transplant,” where CompuMed’s Medical Director, Dr. Robert Shiroff, helps explain the process and its importance in more detail.
The Power of Serial Echoes
As mentioned, the initial echo at 12 hours showed severe hypokinesis and a significantly reduced LVEF of 10-20%.
- At 36 hours: The second echo, this time read by the CompuMed team, confirmed an LVEF of 20% but also included a more detailed description. The new information provided a clearer picture of the affected cardiac segments and gave the OPO team crucial insights to better assess the donor heart’s potential path to recovery.
- At 84 hours: The third echo revealed partial recovery of some cardiac segments, with an improved LVEF of 45-50%, consistent with the expected recovery pattern seen in brain-dead donors.
- At 96 hours: The fourth and final echo demonstrated substantial improvement in cardiac function, with an LVEF of 55% and motion that appeared suitable for transplantation.
Parasternal Short Axis Views
36 hours
84 hours
96 hours
Apical 4 Chamber Views
36 hours
84 hours
96 hours
A Life-saving Outcome
Ultimately, the donor heart was accepted for transplantation and continues to do well for its recipient.
Advocacy & Expertise: Key Takeaways
This case demonstrates the value of serial echoes in identifying a viable donor heart and highlights how persistent advocacy for quality, comprehensive data can make a critical difference in that decision.
To advocate successfully, it helps to understand the heart’s potential recovery patterns, establish clear communication and escalate concerns about resistance to diagnostic procedures to leadership when necessary.
As Dr. Morrow so aptly notes: “Hearts can be very finicky organs, and we have to be willing to fight with the hospital or wherever the donor is located to get serial echoes if it makes sense. Ultimately, that’s the only way we’re going to capture every transplantable organ.”
Lee Morrow, MD
Chief Medical Officer at Live On Nebraska
Dr. Lee Morrow currently serves as the chief medical officer at Live On Nebraska and has been a transplant pulmonologist for almost 25 years. Among his responsibilities at Live On Nebraska, Dr. Morrow trains clinical team members on best practices in patient care, educates physicians at partner hospitals on donation protocols, and leads the organization in advancing its expertise in organ and tissue donation.
More Resources for You
- Hear more insights about serial echoes and donor management from CompuMed’s Dr. Robert Shiroff in this on-demand webinar, “How Serial Echos Can Improve Utilization.”
- Did you know? CompuMed can train OPO team members to perform echocardiograms. Contact us today to see how we can work together to increase the efficiency and timeliness of donor heart evaluations.
- If you’re suffering from a lack of consistency in your current cardiology interpretations, the CompuMed team can help. Learn more about how our small core reading group and innovative AI technology can increase standardization and transparency for you and your transplant center partners.
