Ethylene Glycol Poisoning Should Not Contraindicate Liver Donation

Abstract

As the number of patients waiting to receive transplants increases, there is a need to explore all possible donation opportunities. In this case report, we describe the transplantation of a liver from a donor who died after ethylene glycol poisoning into a woman with alcoholic liver disease with cirrhosis and associated ascites. Donor management, including ethanol, fomepizol and haemodialysis, hastened clearance of ethylene glycol from the circulation, and after liver transplantation, the recipient exhibited no adverse effects suggestive of ethylene glycol toxicity, although recipient hepatic artery dissection and thrombosis necessitated retransplantation. Our experience suggests that donor death due to ethylene glycol intoxication should not contraindicate liver transplantation, particularly after appropriate donor management.

Successful Multiorgan Donation From a Brain-dead Donor Following Liquid Nicotine Voluntary Intoxication: A Case Report

“…Liver biopsy, hemodialysis to accelerate toxic clearance, and verification of the absence of the toxic substance in blood samples are the suggested strategies to optimize results. 13 - 15 …”

“…Liver biopsy, hemodialysis to accelerate toxic clearance, and verification of the absence of the toxic substance in blood samples are the suggested strategies to optimize results. [13][14][15] Liquid nicotine is a widely available, increasingly popular, and insufficiently regulated substance. Attention should be paid to the potential lethal risk of liquid nicotine intoxication, and efforts should be made to devise more thorough surveillance and avoid such unfortunate events.…”

The debate on paracetamol hepatotoxicity continues

“…14 Reaching a final conclusion on the hepatotoxicity of paracetamol contaminated with diethylene glycol is difficult, as ethylene glycol poisoning has not been considered to be a contraindication for donor livers used in transplants. 15 These data on diethylene glycol liver injury prompts two questions. Firstly, did the adeno-associated virus type 2, plus the adenovirus and/or other viruses cause some minor hepatitis that was then aggravated by inadvertent paracetamol overdosing and responsibleforadrug-inducedliverinjury?Secondly,werelocalclustersof paediatric severe acute hepatitis of unknown origin caused by substandard or falsified paracetamol containing diethylene glycol and/ or other contaminants and/or uncontrolled higher concentrations of the active drug in children predisposed by particular human leukocyte antigens?…”

“…Reaching a final conclusion on the hepatotoxicity of paracetamol contaminated with diethylene glycol is difficult, as ethylene glycol poisoning has not been considered to be a contraindication for donor livers used in transplants 15 …”