Finding into death of Andrew Westley

56y · Male·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

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.