CPT® Code 33930

1. Indications

The donor cardiectomy-pneumonectomy procedure, as described by CPT® Code 33930, is indicated in specific circumstances related to organ donation. The primary indication for this procedure is the confirmation of brain death in a potential organ donor. This condition must be established through rigorous medical evaluation to ensure that the donor is suitable for organ procurement. The procedure is performed to facilitate the removal of the heart and lungs for transplantation into recipients who are in need of these vital organs due to various medical conditions, such as heart failure or severe respiratory diseases.

• Brain Death Confirmation The donor must be confirmed as brain dead, which is a critical prerequisite for organ donation.
• Organ Procurement The procedure is performed to procure the heart and lungs for transplantation into recipients.

2. Procedure

The donor cardiectomy-pneumonectomy procedure involves several detailed steps to ensure the successful removal of the heart and lungs.

• Step 1: Examination of the Donor Following the confirmation of brain death, the organ procurement team conducts a thorough examination of the donor to assess the viability of the organs for transplantation.
• Step 2: Bronchoscopy A bronchoscopy is performed to evaluate the condition of the lungs, ensuring they are suitable for donation.
• Step 3: Median Sternotomy The surgical team performs a median sternotomy, which involves making an incision along the sternum to access the thoracic cavity. This incision is extended to also expose the abdominal organs, allowing for a comprehensive view and access to the heart and lungs.
• Step 4: Inspection and Dissection The heart and lungs are carefully inspected for any abnormalities. Preliminary dissection of the lungs and heart is performed to prepare them for removal.
• Step 5: Cannulation The pulmonary artery and aorta are cannulated, which involves inserting tubes into these major blood vessels to facilitate the perfusion process.
• Step 6: Cross-Clamping and Perfusion The aorta is cross-clamped to halt blood flow, allowing the body to be perfused with cold saline solution. This step is essential for preserving the organs by cooling them.
• Step 7: Organ Removal After perfusion, the heart and both lungs are carefully excised from the donor's body.
• Step 8: Organ Preservation The excised heart and lungs are placed in sterile bags, which are then placed on ice to maintain a low temperature during transport to the recipient site.

3. Post-Procedure

Post-procedure care involves the careful handling and transportation of the excised heart and lungs to the recipient site. The organs must be kept at a low temperature to ensure their viability for transplantation. The organ procurement team is responsible for ensuring that the organs are delivered promptly and safely to the surgical team at the recipient facility. There are no specific post-procedure care instructions for the donor, as the procedure is performed on a deceased individual. However, the success of the transplantation process relies heavily on the meticulous execution of the donor cardiectomy-pneumonectomy procedure and the subsequent care of the organs during transport.