Poisoned patients as potential organ donors: postal survey of transplant centres and intensive care units

Abstract

BackgroundThe number of patients awaiting allograft transplantation in the UK exceeds the number of organs offered for transplantation each year. Most organ donors tend to be young, fit and healthy individuals who die because of trauma or sudden cardiac arrest. Patients who die from drug and poison intoxication tend to have similar characteristics but are less frequently offered as potential organ donors.MethodsA postal questionnaire survey of all transplantation centres and an equal number of intensive care units in the UK was undertaken. The use of kidney, heart, lung, liver and pancreas transplants from poisoned patients following deliberate methanol ingestion, cardiac arrest presumed secondary to cocaine overdose, accidental domestic carbon monoxide inhalation and industrial cyanide exposure were used as case scenarios.ResultsResponse rates were 70% for transplantation centres and 50% for intensive care unit directors. Over 80% of organs would be offered or discussed with transplant coordinators by intensive care unit directors. Transplantation physicians/surgeons would consider transplanting organs in up to 100% of case scenarios, depending on the organ and poisoning or intoxication involved.DiscussionThe postal survey presented here shows that most transplantation physicians and surgeons and intensive care unit directors would consider those who die following acute drug intoxication and poisoning as potential organ donors. The previously reported literature shows in general that transplanted organs from poisoned patients have good long-term survival, although the number of reports is small. Poisoned patients are another pool of organ donors who at present are probably underused by transplantation services.

Successful Renal Transplantation after Presumed Cyanide Toxicity Treated with Hydroxocobalamin and Review of the Literature

“…The first published case report of a successful organ transplant from a donor, whose cause of death was cyanide toxicity, was published in 1987 [ 13 ]. Several additional case reports and small series echoed the findings that cyanide toxicity itself was not a contraindication to transplant [ 14 – 17 ]. Since 2006, hydroxocobalamin has established itself as the gold standard antidote for cyanide toxicity replacing amyl nitrate and sodium thiosulfate.…”

Successful Cardiac, Lung, and Kidney Transplantation from a Methanol-poisoned Donor

“…Most of them indicated favorable long-term graft function and recipient survival ( Table 1 ) (7) , (8) , (9) , (10) , (11) , (12) , (13) , (14) , (15) . Although available data including the follow-up period are limited, it is most likely that the survival of organ grafts procured from donors who died due to methanol does not differ in the short- and long-term from transplants performed with organs from donors who died from other causes (16) .…”

Unexpected carboxyhemoglobin half-life during cardiopulmonary resuscitation: a case report

“…The 2015 guidelines of the European Resuscitation Council concluded that there is an unproven benefit of transporting patients with ROSC to an HBO 2 therapy facility and that such a decision must be considered on a case-by-case basis [ 37 ]. Transfer to a tertiary referral hospital could be partly motivated by the possible consideration of organ donation [ 44 , 45 ].…”