Terada Y, Takahashi T, Pasque MK, Kreisel D, Pawale A. Donor heart injury caused by liver needle biopsy during multi-organ procurement surgery: A case report. World J Transplant 2026; 16(2): 119012 [DOI: 10.5500/wjt.v16.i2.119012]
Corresponding Author of This Article
Yuriko Terada, MD, PhD, Department of Thoracic Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Kanazawa 9208641, Ishikawa, Japan. yuriko.terada@gmail.com
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Transplantation
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case-report
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Terada Y, Takahashi T, Pasque MK, Kreisel D, Pawale A. Donor heart injury caused by liver needle biopsy during multi-organ procurement surgery: A case report. World J Transplant 2026; 16(2): 119012 [DOI: 10.5500/wjt.v16.i2.119012]
World J Transplant. Jun 18, 2026; 16(2): 119012 Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.119012
Donor heart injury caused by liver needle biopsy during multi-organ procurement surgery: A case report
Yuriko Terada, Tsuyoshi Takahashi, Michael K Pasque, Daniel Kreisel, Amit Pawale
Yuriko Terada, Tsuyoshi Takahashi, Michael K Pasque, Daniel Kreisel, Amit Pawale, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63108, United States
Yuriko Terada, Tsuyoshi Takahashi, Department of Thoracic Surgery, Kanazawa University, Kanazawa 9208641, Ishikawa, Japan
Author contributions: Terada Y and Takahashi T conceived and designed the study, collected the data, and drafted the manuscript; Pasque ML and Kreisel D were critically revised the manuscript for important intellectual content; Pawale A contributed to data interpretation and manuscript revision; and all authors read and approved the final manuscript and agree to be accountable for all aspects of the work.
Informed consent statement: This manuscript is a case report describing an intraoperative injury involving a deceased organ donor during multi-organ procurement surgery. This report does not include any intervention, treatment, or identifiable information related to a living patient, and no recipient-specific identifiable data are presented.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Yuriko Terada, MD, PhD, Department of Thoracic Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Kanazawa 9208641, Ishikawa, Japan. yuriko.terada@gmail.com
Received: January 19, 2026 Revised: February 9, 2026 Accepted: April 13, 2026 Published online: June 18, 2026 Processing time: 132 Days and 6.8 Hours
Abstract
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
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.
Core Tip: Organ procurement injuries during multi-organ recovery are considered rare, but they can result in irreversible loss of otherwise transplantable organs and may be underreported in national registries. We describe an unusual case in which a liver core needle biopsy performed during abdominal procurement caused transdiaphragmatic puncture injury to the donor heart, leading to intraoperative heart decline at the donor hospital. This case highlights a preventable mechanism of donor heart loss and emphasizes the importance of coordination, timing, and protective strategies among procurement teams to avoid avoidable organ injury.
