Successful liver transplantation from a donor with brodifacoum intoxication

Abstract

We describe our use of a liver allograft from a donor who died of intracranial hemorrhage after brodifacoum ingestion. Because brodifacoum can remain in the human body for months, the recipient's posttransplantation coagulation profiles and serum brodifacoum levels were monitored closely. Her posttransplantation course was excellent, with no coagulation problem. At 15 months posttransplantation, she is well, with normal liver function and coagulation profile. We conclude that brodifacoum toxicity is not a strict contraindication to liver donation.

Pesticide-Poisoned Patients: Can They Be Used as Potential Organ Donors?

“…Ten articles were identified in the PubMed search describing 20 deaths where organ donation occurred following exposure to a pesticide; no additional reports were identified from the EAPCCT and NACCT abstracts [13][14][15][16][17][18][19][20][21][22].…”

“…The earliest identified published case was from 1999 and involved successful liver donation from a 21-year-old male who was found unconscious following a seizure with subsequent detection of an intracranial haemorrhage and associated hydrocephalus following a brodifacoum overdose (analytically confirmed high blood brodifacoum concentrations and deranged coagulation screens). The recipient was a 45-year-old woman with a background of recurrent localised nonmetastatic hepatocellular carcinoma secondary to hepatitis B and no metastases: the postoperative clinical course was uneventful, and at 15-month follow-up the donor recipient remained tumor-free with normal liver function [22].…”

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][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.…”

Comment on: Pesticide-Poisoned Patients: Can They Be Used as Potential Organ Donors?

“…To the Editor: We read with interest the review article by Mistry et al [1] on solid organ donation from patients who died from pesticide poisoning. To this end, the authors found that one donor was poisoned with brodifacoum (BDF), a long-acting, secondgeneration anticoagulant lipophilic rodenticide that accumulates preferentially in the liver [2,3]. However, review of the literature indicates that BDF poisoning led to death of two additional patients from whom multiple organs [4] and two kidneys [5] were procured.…”

“…However, review of the literature indicates that BDF poisoning led to death of two additional patients from whom multiple organs [4] and two kidneys [5] were procured. Interestingly, Emre et al [2] observed a transient vitamin K1-responsive coagulopathy during post-transplant reperfusion despite undetectable brodifacoum in the blood (< 4.0 ng/mL). The authors hypothesized that this phenomenon was related, in part, to residual BDF in the transplanted liver that cleared after the operation.…”