................................................................................................................................. .............................................................. .............................................................. RESEARCH Case report Q The benefit of smart phone usage in liver organ procurement Kris P Croome* † , Jeff Shum* † , Mamoun A Al-Basheer*, Hideya Kamei*, Michael Bloch*, Douglas Quan* † and Roberto Hernandez-Alejandro* † *Multi-Organ Transplant Program, London Health Sciences Centre, University of Western Ontario, London, Canada; † Department of Surgery, Division of General Surgery, University of Western Ontario, London, Canada Summary A 56-year-old man was on the transplant list with end-stage liver disease secondary to hepatitis C when a donor liver became available at a location 545km away. The procurement team, consisting of a senior and junior fellow, went on the retrieval, while the staff surgeon remained in the hospital with the recipient. At the time of organ procurement, a suspicious lesion was identified in the left lateral lobe. The transplant fellows took intraoperative pictures of the lesion with a smart phone and sent them to the staff surgeon for advice. A teleconsultation, facilitated by images sent from the smart phone, took place over the next 22 min. The decision was made to proceed with the transplant, as it was felt that the lesion could be resected from the liverallograft. Had the fellows not been able to interact with the staff surgeon in real-time during the surgery, there is a high likelihood that the organ would have been rejected by the staff surgeon due to the unexpected finding. The patient’s postoperative course was relatively uneventful with no evidence of infection. The patient was discharged from hospital and continues to do well. We expect that the role of smart phones in remote consultation will continue to expand in future. Introduction The use of smart phones such as the RIM BlackBerry, the Apple iPhone or the Google Android is becoming increasingly common in medicine. 1,2 Smart phones have a wide range of applications from specific programs such as pharmacopoeias and medical calculators, to real-time telesurgery consultations. 3 Smart phones have also been used to allow specialists to conduct remote consultations for stroke patients. 1,3 In many Canadian transplantation programmes, trained fellows are sent to perform the organ procurement while the staff surgeon remains at the recipient site. At the time of procurement, decisions must be made about the quality of the donor liver, even though there will have been an extensive work-up by the organ procurement organization. If the allograft is found to be of poor quality then the team will communicate this to the staff surgeon who must decide whether or not to reject the organ without observing the organ characteristics personally. The present report concerns a case in which smart phones were used in real- time to gain a staff opinion in the evaluation of a donor liver during organ procurement at a remote site. Case report A 56-year-old man was on the transplant list with end-stage liver disease secondary to hepatitis C. He had been admitted to hospital with the decompensated features of liver failure and continued to deteriorate following admission with hepatorenal syndrome and severe hepatic encephalopathy and a Model of End Stage Liver Disease (MELD) score of 34. 4 A donor liver then became available at a location 545 km away. The donor was a middle-aged male who had sustained brain death from head trauma with no previous medical or surgical history. The patient was afebrile, had a normal white blood cell count and was on low dose pressors. The procurement team, consisting of a senior and junior fellow went on the retrieval, while the staff surgeon remained in the hospital with the recipient. At the time of procurement, a lesion was identified in the left lateral lobe. The following discussion ensued over a 22 min period, via smart phones (BlackBerry Bold with 3.2 megapixel camera): (1) The transplant fellows took intraoperative pictures of the lesion with a smart phone and sent them to the staff surgeon for advice (Figure 1). (2) The staff surgeon responded by asking for measurements of the lesion as well as a more detailed description of the lesion’s texture, consistency and any Accepted 26 October 2010 Correspondence: Kris P Croome, Department of Surgery, Division of General Surgery, University of Western Ontario, 330 Windermere Road, London, Ontario N6A 5A5, Canada (Fax: þ1 519 663 3858; Email: krisbelize@hotmail.com) Journal of Telemedicine and Telecare 2011; 17: 158–160 DOI: 10.1258/jtt.2010.100907