Bacterial Infection during Adult Donor Care

Abstract

Assessment, prevention, and treatment of bacterial infection in donors are critically important to the welfare of grafts and recipients after transplantation. Transmission of bacterial, viral, fungal, and protozoan infections from a donor to recipient(s) has been documented to have serious or fatal consequences. This article reviews issues of bacterial infection only. The organ procurement coordinator, supported by guidelines developed and prospectively modified by the organ procurement organization, must assess the donor for the presence and severity of bacterial tissue invasion and administer appropriate antimicrobial agents during donor care. Continuation of infection control measures, obtaining serial or surveillance samples for culture, review of antibiotic sensitivity data, initiation of empiric treatment, and modification of medications or their dosing are components of this important responsibility during donor care.

Transplant Infectious Disease: Implications for Critical Care Nurses

“…The acceptance of organs from donors with known infections with or exposure to HIV, hepatitis, or other viruses remains controversial. 21 Given that the number of transplant candidates on the waiting list far exceeds the number of available organs, strategies to expand the donor pool include accepting donors with certain infections, higher-risk serological profiles, and social histories suggestive of prior exposure to bloodborne infections as well as donors who may be more at risk for transmitting infections (eg, older donors and donors with long ICU stays). 20 Informed consent Table 3 Acceptance or exclusion of donor organs based on infectious disease testing 23 mandates that potential recipients be informed of the donor's infection status and the risk of infection transmission associated with that particular donor.…”

“…Principles of antibiotic selection and administration for potential organ donors 21 1. Select a bactericidal antibiotic over a bacteriostatic antibiotic.…”

“…20 It is important to note that treatment of donor infections itself can further increase the potential donor's risk of iatrogenic infection, for example, via the insertion of intravascular catheters for antimicrobial therapy, the administration of immunomodulating medications such as corticosteroids, and prolonged hospitalization. 21…”

“…• The donor's white blood cell count may be already elevated due to trauma, tissue inflammation, or medications such as corticosteroids. 21 As a consequence, the diagnosis of infection may rely on culture and urinalysis reports, polymerase chain reaction (PCR) and nucleic acid testing results, characteristics of sputum, and changes in chest radiographs and computed tomography (CT) scans. 21…”

“…Effective treatment of bacterial infections in potential organ donors can result in successful transplantation. 21 Box 1 displays important principles of antibiotic selection and administration for potential organ donors.…”