Coronial
VIChospital

Finding into death of Andrew Westley

Deceased

ANDREW WESTLEY

Demographics

56y, male

Date of death

2008-07-10

Finding date

2011-10-20

Cause of death

Cardiogenic shock, end stage ischemia due to chemo related cardiomyopathy, fulminant respiratory failure, VRE sepsis and aspergillus and hepatic and renal failure complicated by heart transplant needing ECMO for 30 days, LVAD and RVAD

AI-generated summary

Andrew Westley, 56, underwent heart transplantation at The Alfred Hospital for dilated cardiomyopathy secondary to chemotherapy for Hodgkins lymphoma and prior cardiac surgery. The procedure involved a 9-hour ischaemic time due to delayed recipient arrival, difficult explantation (prior surgery/radiotherapy causing adhesions), and organ procurement from far North Queensland. Post-operatively, he required prolonged ECMO, IABP, and biventricular assist devices but developed VRE sepsis, aspergillus infection, and multi-organ failure, dying 30 days post-transplant. Expert review found the decision to proceed was reasonable but high-risk given non-optimal donor quality and complex recipient factors. The case led to institutional changes: fewer Queensland donors accepted and elective ECMO now considered for ischaemic times exceeding 6 hours.

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.

Specialties

cardiothoracic surgerytransplant medicineintensive careanaesthesiagastroenterology

Error types

delay

Drugs involved

vancomycininotropes

Clinical conditions

dilated cardiomyopathychemotherapy-related cardiotoxicitycardiogenic shockmulti-organ failuresepsisaspergillus infectionVRE bacteraemiahepatic failurerenal failurerespiratory failure

Procedures

heart transplantationcardiopulmonary bypassintra-aortic balloon pump insertionextra corporeal membrane oxygenationtransoesophageal echocardiographycardiac biopsygastroscopyleft ventricular assist device insertionright ventricular assist device insertion

Contributing factors

  • Prolonged ischaemic time of 9 hours
  • Delayed recipient arrival due to flight delay
  • Difficult recipient operation due to severe adhesions from prior surgery and radiotherapy
  • Non-optimal donor quality (54-year-old smoker)
  • Prolonged organ procurement time from far North Queensland
  • Post-operative complications including VRE sepsis and aspergillus infection
  • Multi-organ failure developing post-transplant

Coroner's recommendations

  1. Institutional change implemented: very few organs now accepted from Queensland donors due to distance and procurement uncertainty
  2. Institutional change implemented: elective extra corporeal membrane oxygenation (ECMO) support now considered for any ischaemic time in excess of 6 hours
  3. Publication of this decision on the court's website to highlight risks associated with transplants, particularly with prolonged ischaemic times
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