Efforts to increase deceased donation have included the use of US Public HealthService (PHS) high-risk donors. The homeless have high rates of medical and substance abuse issues that are often unrecognized. This study investigates whether the homeless should become suitable organ donors. We retrospectively reviewed 193 brain-dead prospective donors from Hawaii's organ procurement organization (OPO; 2013-2018) and compared two groups: homeless (n = 13) and non-homeless (n = 180) prospective donors. The homeless prospective donors were older (48.0 vs 40.7 years, P = .009) and had more substance abuse (30.8% vs 10%, P = .046), methamphetamine use (53.8% vs 12.2%, P = .001), cocaine use (23.1% vs 3.9%, P = .022), and urine with amphetamines (54.5% vs 17.9%, P = .049). The homeless prospective donors trended toward more PHS high-risk designation (50% vs 19%, P = .062). There was no difference in medical history, gender/race, hepatitis serologies, authorization for donation, and organs procured/transplanted between prospective donors.We have provided evidence that the homeless should become prospective organ donors; however, they have more high-risk behaviors and often have limited information. Larger studies from OPOs are needed to better characterize organ donation and track disease transmission in this population. K E Y W O R D Salcoholism and substance abuse, deceased, extended criteria, organ procurement organization 2 of 7 | LEE Et aL. chronic homelessness (≥1 year). 10 Homelessness has been shown to be an independent risk factor for increased mortality with higher rates of infection (HIV, hepatitis C, tuberculosis), heart disease, suicides, homicides, and drug overdose. [11][12][13][14] In addition, there is a higher prevalence of alcohol, smoking, and illicit substance abuse.Within the homeless population, there are particularly high mortality risk groups including those who were recently discharged from psychiatric hospitals, prisons, and the child-welfare system. 15,16 Little is known about whether homelessness would affect organ donation or increase disease transmission. Anticipated issues would include proper identification of individuals, location of next of kin, eliciting reliable medical and psychosocial histories, and obtaining authorization for donation. Limited information on recent exposures in a high-risk population may potentially increase infectious disease transmission. The only previous study showed that in 10 donor hearts from homeless donors, poorer outcomes were observed with a 50% mortality rate at 3 years post-transplantation due to elevated rates of rejection and infection. 17 In this study, we characterize deceased prospective donors who are homeless in Hawaii and evaluate whether homelessness affects disease transmission and outcome. | ME THODSThis was a retrospective study in Hawaii between 2013 and 2018. Records were obtained from Hawaii's only organ procurement organization (OPO), Legacy of Life Hawaii (LLH), and included only those brain-dead prospective organ donors. Donation after ...

Iliac vein injury in the absence of pelvic fractures is rare. We present the case of a 27-year-old male involved in a motorcycle crash. Imaging demonstrated a lumbar hernia and pelvic hematoma in the absence of pelvic fractures. The patient became unstable and required emergency surgery demonstrating an iliac vein injury requiring ligation. Diagnosis and management of this rare injury is reviewed.

Scrotal and testicular injuries are uncommon injuries, accounting for only a fraction of all trauma. Blunt scrotal trauma is accompanied by testicular rupture in up to 50% of cases. We present a rare case of scrotal rupture with evisceration of a viable, intact testicle after a motor vehicle accident. The patient's presentation, associated injuries, operation, and post-operative course are described. In brief, this is a case of a 69-year-old male who sustained multiple rib, pelvic, and right femur fractures in addition to scrotal injury after a motor vehicle accident. He was taken quickly to the operating room for the scrotal rupture, and his testicle was successfully replaced and scrotal laceration repaired. He did well post-operatively. This case represents one of the few accounts of this particular injury in the literature.

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