Modified cardiectomy: documenting sudden cardiac death in hearts selected for valve allograft procurement

Medical examiners frequently deny requests by tissue procurement organizations for heart valves intended for allograft transplantation. Most of these denials are in cases of sudden apparent natural death, often where a cardiac cause is suspected. The basis of denial in these cases is that the heart must be removed and the valves procured off site under sterile conditions. This prevents the medical examiner from determining and documenting the cause of death. A dissection technique was therefore devised to increase the number of heart valves available for allograft transplantation and to simultaneously allow the pathologist to document a cardiac cause of sudden death. Interagency procedures, the dissection technique, and case summaries are provided.