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Copeland H, Knezevic I, Baran DA, Rao V, Pham M, Gustafsson F, Pinney S, Lima B, Masetti M, Ciarka A, Rajagopalan N, Torres A, Hsich E, Patel JK, Goldraich LA, Colvin M, Segovia J, Ross H, Ginwalla M, Sharif-Kashani B, Farr MA, Potena L, Kobashigawa J, Crespo-Leiro MG, Altman N, Wagner F, Cook J, Stosor V, Grossi PA, Khush K, Yagdi T, Restaino S, Tsui S, Absi D, Sokos G, Zuckermann A, Wayda B, Felius J, Hall SA. Donor heart selection: Evidence-based guidelines for providers. J Heart Lung Transplant 2023; 42:7-29. [PMID: 36357275 PMCID: PMC10284152 DOI: 10.1016/j.healun.2022.08.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023] Open
Abstract
The proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review.
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Affiliation(s)
- Hannah Copeland
- Department of Cardiovascular and Thoracic Surgery Lutheran Hospital, Fort Wayne, Indiana; Indiana University School of Medicine-Fort Wayne, Fort Wayne, Indiana.
| | - Ivan Knezevic
- Transplantation Centre, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David A Baran
- Department of Medicine, Division of Cardiology, Sentara Heart Hospital, Norfolk, Virginia
| | - Vivek Rao
- Peter Munk Cardiac Centre Toronto General Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Michael Pham
- Sutter Health California Pacific Medical Center, San Francisco, California
| | - Finn Gustafsson
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sean Pinney
- University of Chicago Medicine, Chicago, Illinois
| | - Brian Lima
- Medical City Heart Hospital, Dallas, Texas
| | - Marco Masetti
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of Civilisation Diseases and Regenerative Medicine, University of Information Technology and Management, Rzeszow, Poland
| | | | - Adriana Torres
- Los Cobos Medical Center, Universidad El Bosque, Bogota, Colombia
| | | | | | | | | | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Heather Ross
- University of Toronto, Toronto, Ontario, Canada; Sutter Health California Pacific Medical Center, San Francisco, California
| | - Mahazarin Ginwalla
- Cardiovascular Division, Palo Alto Medical Foundation/Sutter Health, Burlingame, California
| | - Babak Sharif-Kashani
- Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MaryJane A Farr
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luciano Potena
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | | | | | | | | | | | - Valentina Stosor
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kiran Khush
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Tahir Yagdi
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Susan Restaino
- Division of Cardiology Columbia University, New York, New York; New York Presbyterian Hospital, New York, New York
| | - Steven Tsui
- Department of Cardiothoracic Surgery Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Daniel Absi
- Department of Cardiothoracic and Transplant Surgery, University Hospital Favaloro Foundation, Buenos Aires, Argentina
| | - George Sokos
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Brian Wayda
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Joost Felius
- Baylor Scott & White Research Institute, Dallas, Texas; Texas A&M University Health Science Center, Dallas, Texas
| | - Shelley A Hall
- Texas A&M University Health Science Center, Dallas, Texas; Division of Transplant Cardiology, Mechanical Circulatory Support and Advanced Heart Failure, Baylor University Medical Center, Dallas, Texas
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Matar AJ, Magliocca JF, Kitchens WH. Successful Liver Transplantation from a Deceased Donor After Ethylene Glycol Ingestion: A Case Report and Review of the Literature of Organ Donation from Poisoned Donors. Transplant Proc 2022; 54:128-134. [PMID: 34972567 DOI: 10.1016/j.transproceed.2021.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022]
Abstract
Despite the increase in deceased organ donation over the past ten years, the gap between patients awaiting transplant and available organs continues to widen. Deceased donors secondary to acute fatal poisonings represent less than 1% of all organ donors. Organs from poisoned donors have largely been discarded due to concerns of toxin transmission and poor organ function as well as the paucity of data that exists regarding this donor population. Here, we report a case of a 40-year-old male who underwent successful liver re-transplantation from a donor who died following ethylene glycol ingestion. To our knowledge this case report is the first to describe successful re-transplantation from an ethylene glycol-poisoned donor. We also provide a comprehensive review of the literature describing organ donation from poisoned donors.
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Affiliation(s)
- Abraham J Matar
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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3
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The impact of donor urine chemical toxicology analysis on outcomes of kidney transplantation. Int Urol Nephrol 2020; 52:1173-1178. [DOI: 10.1007/s11255-020-02450-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/16/2020] [Indexed: 11/26/2022]
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Fujisaki N, Nakao A, Osako T, Nishimura T, Yamada T, Kohama K, Sakata H, Ishikawa-Aoyama M, Kotani J. Can carbon monoxide-poisoned victims be organ donors? Med Gas Res 2014; 4:13. [PMID: 25097755 PMCID: PMC4121619 DOI: 10.1186/2045-9912-4-13] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/21/2014] [Indexed: 01/02/2023] Open
Abstract
The increasing demand for organ allografts to treat end-stage organ failure has driven changes in traditional donor criteria. Patients who have succumbed to carbon monoxide (CO) poisoning, a common cause of toxicological mortality, are usually rejected as organ donors. To fulfill the increasing demand, selection criteria must be expanded to include CO-poisoned donors. However, the use of allografts exposed to high CO concentrations is still under debate. Basic research and literature review data suggest that patients with brain death caused by CO poisoning should be considered appropriate organ donors. Accepting organs from CO-poisoned victims could increase the number of potential donors and lower the death rate of patients on the waiting lists. This review and reported cases may increase awareness among emergency department physicians, as well as transplant teams, that patients dying of CO exposure may be acceptable organ donors.
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Affiliation(s)
- Noritomo Fujisaki
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Atsunori Nakao
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takaaki Osako
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takeshi Nishimura
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Taihei Yamada
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Keisuke Kohama
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroyuki Sakata
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Michiko Ishikawa-Aoyama
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Joji Kotani
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Vettel C, Hottenrott MC, Spindler R, Benck U, Schnuelle P, Tsagogiorgas C, Krämer BK, Hoeger S, El-Armouche A, Wieland T, Yard BA. Dopamine and Lipophilic Derivates Protect Cardiomyocytes against Cold Preservation Injury. J Pharmacol Exp Ther 2013; 348:77-85. [DOI: 10.1124/jpet.113.207001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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The Role of the Medical Toxicologist in Organ Transplantation. J Med Toxicol 2012; 8:247-9. [DOI: 10.1007/s13181-012-0235-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Ozaki KS, Kimura S, Murase N. Use of carbon monoxide in minimizing ischemia/reperfusion injury in transplantation. Transplant Rev (Orlando) 2011; 26:125-39. [PMID: 22000659 DOI: 10.1016/j.trre.2011.01.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 01/20/2011] [Indexed: 01/27/2023]
Abstract
Although carbon monoxide (CO) is known to be toxic because of its ability to interfere with oxygen delivery at high concentrations, mammalian cells endogenously generate CO primarily via the catalysis of heme by heme oxygenases. Recent findings have indicated that heme oxygenases and generation of CO serve as a key mechanism to maintain the integrity of the physiological function of organs and supported the development of a new paradigm that CO, at low concentrations, functions as a signaling molecule in the body and exerts significant cytoprotection. Consequently, exogenously delivered CO has been shown to mediate potent protection in various injury models through its anti-inflammatory, vasodilating, and antiapoptotic functions. Ischemia/reperfusion (I/R) injury associated with organ transplantation is one of the major deleterious factors limiting the success of transplantation. Ischemia/reperfusion injury is a complex cascade of interconnected events involving cell damage, apoptosis, vigorous inflammatory responses, microcirculation disturbance, and thrombogenesis. Carbon monoxide has a great potential in minimizing I/R injury. This review will provide an overview of the basic physiology of CO, preclinical studies examining efficacy of CO in I/R injury models, and possible protective mechanisms. Carbon monoxide could be developed to be a valuable therapeutic molecule in minimizing I/R injury in transplantation.
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Affiliation(s)
- Kikumi S Ozaki
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
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9
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Solid organ procurement from donors with carbon monoxide poisoning and/or burn--a systematic review. Burns 2011; 37:814-22. [PMID: 21382666 DOI: 10.1016/j.burns.2011.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 01/29/2011] [Accepted: 02/02/2011] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Traditionally, carbon monoxide poisoning and/or burn are considered contraindications to organ procurement. Previously reported cases have shown mixed results and many have been redundantly reported in the literature. METHODS We performed a systematic review of all reported cases of organ transplantation procured from donors with carbon monoxide poisoning and/or burn to investigate whether these patients are suitable donors for solid organ transplantations. RESULTS Organ survival rates of reported organs were high (86%). All organs procured from donors with carbon monoxide poisoning and burn survived during follow-up. Mean donors' peak carbon monoxide levels were comparable for organs surviving or failing during follow-up (31 ± 2.7 vs. 29 ± 26.8; p=0.95). Eighty-seven per cent of organs procured from donors supported with inotropes or vasopressors prior to organ procurement and 91% of organs procured from donors who were cardiopulmonary resuscitated prior to organ procurement survived during follow-up. CONCLUSIONS Burn, carbon monoxide poisoning, high peak carbon monoxide-levels, use of inotropes or vasopressors or cardiopulmonary resuscitation prior to procurement are not contraindications for organ procurement and transplantation. New guidelines for burn units defining the special requirements for organ procurement from donors with carbon monoxide poisoning and/or burn are needed to raise the awareness for potential organ donors and to ultimately increase the donor pool and save patients' lives.
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Muerte encefálica: consideraciones clínicas y legales. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70520-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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11
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Martìn-Suàrez S, Mikus E, Pilato E, Bacchini M, Savini C, Grigioni F, Coccolo F, Marinelli G, Mikus P, Arpesella G. Cardiac Transplantation From a Carbon Monoxide Intoxicated Donor. Transplant Proc 2008; 40:1563-5. [DOI: 10.1016/j.transproceed.2008.03.155] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 03/06/2008] [Indexed: 11/26/2022]
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Successful Cardiac Transplantation From Donor With Carbon Monoxide Intoxication: A Case Report. Transplant Proc 2008; 40:324-5. [DOI: 10.1016/j.transproceed.2007.11.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Wittwer T, Wahlers T. Marginal donor grafts in heart transplantation: lessons learned from 25 years of experience. Transpl Int 2007; 21:113-25. [DOI: 10.1111/j.1432-2277.2007.00603.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
The success of cardiac transplantation has led to its widespread application for all etiologies of end-stage heart disease. As a result, this has resulted in a severe shortage of available donor organs. In light of an increasing organ demand with a stable supply, efficacious donor management and meticulous selection is crucial in maintaining excellent outcomes with cardiac transplantation. It is now increasingly common to push the envelope by expanding criteria for donor selection. This has translated into harvesting of older donor hearts, from more unstable donors as well as from more distant locations. Of utmost importance is that when the decision is made to proceed with cardiac transplantation, the risk/benefit ratio associated with cardiac transplantation in that particular patient must be weighed against the mortality and morbidity risk while remaining on the heart transplant waiting list.
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Affiliation(s)
- Ranjit John
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
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Abstract
BACKGROUND There is an increasing gap between the number of patients on the waiting list and the number of transplanted patients. In France, more than 10000 patients waited for an organ transplantation in 2002. Due to the graft shortage, "marginal" donors are now considered. The patients who present brain death after accidental or voluntary poisoning belong to this category. EPIDEMIOLOGY The data available from European or North American organ procurement organisations show that poisoned donors represent about 1% of all organ donors. It seems likely that a significant number of poisoned patients are not referred because poisoning is regarded as a contraindication to organ donation. When organ procurement can be achieved, the results expressed as recipient survival or graft survival are quite encouraging. TOXIC PRODUCTS The most frequently involved toxins are either drugs (psychotropic agents, analgesics...), illicit substances, or environmental agents (gases, alcohols...). The literature data are discussed; some issues remain controversial. PRACTICAL APPROACH Several criteria have to be applied when poisoned patients are considered as potential organ donors. Besides a firm diagnosis of "brain death", the knowledge of the "target organs" of poisoning is of paramount importance, together with careful analysis of the toxicokinetics and toxicodynamics. In most cases, routine biological and morphological data are sufficient to assess graft function.
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Affiliation(s)
- Philippe Hantson
- Unité de neurotraumatologie et toxicologie, Département des soins intensifs Cliniques St-Luc, Université catholique de Louvain, Bruxelles, Belgique.
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Wood DM, Dargan PI, Jones AL. Poisoned patients as potential organ donors: postal survey of transplant centres and intensive care units. Crit Care 2003; 7:147-54. [PMID: 12720561 PMCID: PMC270623 DOI: 10.1186/cc1880] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2002] [Revised: 01/03/2003] [Accepted: 01/07/2003] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 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. METHODS A 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. RESULTS Response 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. DISCUSSION The 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.
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Affiliation(s)
- David Michael Wood
- National Poisons Information Service (London), Guy's and St Thomas' Hospital, London, UK.
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Rodrigus IE, Conraads V, Amsel BJ, Moulijn AC. Primary cardiac allograft failure after donor carbon monoxide poisoning treated with biventricular assist device. J Heart Lung Transplant 2001; 20:1345-8. [PMID: 11744421 DOI: 10.1016/s1053-2498(01)00331-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Because of the current donor shortage, organ selection criteria are being progressively liberalized. We present a case of carbon monoxide poisoning in a multiorgan donor that led to primary cardiac allograft failure. A biventricular assist device was used as a bridge to recovery.
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Affiliation(s)
- I E Rodrigus
- Department of Cardiac Surgery, University Hospital Antwerp, Edegem, Belgium.
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Luckraz H, Tsui SS, Parameshwar J, Wallwork J, Large SR. Improved outcome with organs from carbon monoxide poisoned donors for intrathoracic transplantation. Ann Thorac Surg 2001; 72:709-13. [PMID: 11565645 DOI: 10.1016/s0003-4975(01)02808-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The success of intrathoracic organ transplantation has lead to a growing imbalance between the demand and supply of donor organs. Accordingly, there has been an expansion in the use of organs from nonconventional donors such as those who died from carbon monoxide poisoning. We describe our experience with 7 patients who were transplanted using organs after fatal carbon monoxide poisoning. METHODS A retrospective study of the 1,312 intrathoracic organ transplants between January 1979 and February 2000 was completed. Seven of these transplants (0.5%) were fulfilled with organs retrieved from donors after fatal carbon monoxide poisoning. There were six heart transplants and one single lung transplant. The history of carbon monoxide inhalation was obtained in all of these donors. RESULTS Five of 6 patients with heart transplant are alive and well with survival ranging from 68 to 1,879 days (mean, 969 +/- 823 days). One patient (a 29-year-old male) died 12 hours posttransplant caused by donor organ failure. The patient who had a right single lung transplant did well initially after the transplant, but died after 8 months caused by Pneumocystis carinii pneumonia. All those recipients who were transplanted from carbon monoxide poisoned donors and ventilated for more than 36 hours, survived for more than 30 days. Moreover, these donors were assessed and optimized by the Papworth donor management protocol. CONCLUSIONS Carbon monoxide poisoned organs can be considered for intrathoracic transplantation. In view of the significant risk of donor organ failure, a cautious approach is still warranted. Ideally, the donor should be hemodynamically stable for at least 36 hours from the time of poisoning and on minimal support. A formal approach of invasive monitoring and active management further improves the chances of successful outcome.
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Affiliation(s)
- H Luckraz
- Transplant Unit Papworth Hospital, Papworth Everard, Cambridgeshire, United Kingdom.
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Tenderich G, Dagge A, Schulz U, Holzinger J, Hornik L, Mirow N, Minami K, Körfer R. Successful use of cardiac allograft from serotonin antagonist intoxication. Transplantation 2001; 72:529. [PMID: 11502988 DOI: 10.1097/00007890-200108150-00029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Compromised organ donors are generally not accepted for heart transplantation (HT) despite the increasing number of critically ill patients on the waiting lists. By extending the donor criteria to include certain cases of intoxication, the organ shortage may be reduced. METHODS The case of a successful orthotopic HT with an allograft from a donor poisoned by antidepressant overdose is presented. RESULTS Early graft function was satisfactory with anteroseptal dyskinesis and an ejection fraction of 75% on echocardiography. The cardiac allograft recipient suffered some postoperative complications including gastrointestinal problems. The following period was up to now uneventful. Discharge from the intensive care unit was after 4 days. In-hospital stay was prolonged at 26 days. CONCLUSIONS Because of limited myocardial toxicity, donor hearts from certain victims of antidepressant intoxication may be safely used for HT. Existing cardiac organ donor criteria must be reevaluated to maximise the available organ pool.
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Affiliation(s)
- G Tenderich
- Heart and Diabetes Center North Rhine-Westfalia, Department of Thoracic and Cardiovascular Surgery, Ruhr-University of Bochum, Georgstrasse 11, D-32545 Bad Oeynhausen, Germany
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Bentley MJ, Mullen JC, Lopushinsky SR, Modry DL. Successful cardiac transplantation with methanol or carbon monoxide-poisoned donors. Ann Thorac Surg 2001; 71:1194-7. [PMID: 11308158 DOI: 10.1016/s0003-4975(01)02402-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients succumbing to methanol or carbon monoxide poisoning are usually rejected for heart donation. Increasing demand for donors has lead to the expansion of acceptance criteria and increased use of the marginal donor. METHODS We transplanted hearts from donors who had had methanol intoxication in three cases and carbon monoxide exposure in two cases. Standard donor evaluation criteria and transplantation techniques were used. RESULTS All of the transplants were successful. Three of the recipients required significant inotropic support for a few days postoperatively; however, all of the hearts functioned well over the intermediate and long term. Two recipients (1 from each group) died of complications other than heart failure (1.5 and 2 years postoperatively). CONCLUSIONS Successful heart transplantation can be achieved using the hearts from patients succumbing to methanol or carbon monoxide poisoning. Routine evaluation of cardiac function and myocardial damage is adequate for screening these donors. Hearts from methanol-poisoning victims may require longer inotropic support postoperatively before complete recovery, but can provide excellent long-term function and results.
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Affiliation(s)
- M J Bentley
- Division of Cardiothoracic Surgery, The University of Alberta, Edmonton, Canada
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Hantson P, de Tourtchaninoff M, Mahieu P, Guérit J. Prélèvements d'organes consécutifs aux décès par intoxication: expérience et problèmes diagnostiques. ACTA ACUST UNITED AC 2000. [DOI: 10.1016/s1164-6756(00)90006-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tenderich G, Koerner MM, Koerfer RP. Hemodynamic follow-up of cardiac allografts from donors undergoing hemodialysis for chronic renal failure. Transplantation 1999; 68:1064. [PMID: 10532554 DOI: 10.1097/00007890-199910150-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tenderich G, Koerner MM, Posival H, Arusoglu L, Hornik L, Mirow N, Stuettgen B, Wlost S, Minami K, Koerfer R. Hemodynamic follow-up of cardiac allografts from poisoned donors. Transplantation 1998; 66:1163-7. [PMID: 9825812 DOI: 10.1097/00007890-199811150-00009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The current shortage of donor organs, combined with an increasing demand for cardiac allografts, means that extended donor criteria are becoming more and more accepted. The use of cardiac allografts for transplantation from donors after acute poisoning is still under discussion; few data are currently available in the medical literature. We describe our experience with 19 orthotopic heart transplant recipients of organs from donors after acute intoxication with different agents. METHODS Between March 1989 and December 1997, 883 orthotopic heart transplantations were performed at our transplant unit. Within this group, we accepted donor hearts after ethanol intoxication (n=1), benzodiazepine (n=1), alkylphosphate (E 605) in combination with beta-blocker intoxication (n=1), carbon monoxide poisoning (n=5), digitalis (n=1), digitalis/glibenclamide (n=1), chlormethiazole (n=1), propoxyphene (n=1), alkylphosphate (E 605) (n=1), insulin (n=2), neprobamate/ thiocyacide/flurazepam (n=1), paracetamol (n=1), carbamazepine (n=1), and cyanide (n=1) intoxication. At the time of organ explantation, hemodynamic data were available from all patients. RESULTS Early mortality in this group was 11%; cumulative survival after 5 years was 74%. CONCLUSIONS Based on our limited experience, cardiac allografts from donors exposed to different kinds of poisons can be transplanted in selected cases. If the donor organ is not hemodynamically compromised, showing regular filling pressures on low or mild inotropic support just before explantation, and if there are no electrocardiographic changes in combination with elevation of the transaminases, cardiac allograft transplantation seems to be a safe and life-saving procedure.
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Affiliation(s)
- G Tenderich
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
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Tenderich G, Koerner MM, Stuettgen B, Arusoglu L, Bairaktaris A, Hornik L, Wlost S, Mirow N, Minami K, Koerfer R. Extended donor criteria: hemodynamic follow-up of heart transplant recipients receiving a cardiac allograft from donors > or = 60 years of age. Transplantation 1998; 66:1109-13. [PMID: 9808501 DOI: 10.1097/00007890-199810270-00025] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart transplantation (HT) has become a therapeutic option for patients suffering from endstage heart failure. The increasing demand for cardiac allografts has led to a shift toward extended donor criteria. In a retrospective analysis of 859 HT recipients, we report on the hemodynamic outcome of 19 HT patients who received cardiac allografts from donors > or =60 years of age. METHODS From March 1989 to December 1997, we performed 883 orthotopic HT in 74 children and 809 adults at our transplant center. Within this period, 19 patients (17 women and 2 men) received cardiac allografts from donors > or =60 years of age. Recipient age ranged from 57 to 78 years (mean, 65+/-5 years). RESULTS HT could be performed successfully in 19 cases. The early mortality rate was 16% (n=3). The late mortality rate was 37% (n=7). All long-term survivors are stable at New York Heart Association classification II (New York Heart Association Class II = resting hemodynamics: cardiac output normal; left ventricular end diastolic filling pressure elevated; clinically not compromised during mild to moderate workout). Although only 19 patients were retrospectively evaluated, there was a statistically significant (P<0.05) difference in survival among patients who received organs from male (11 vs. 8*) compared with female (8 vs. 2*) (*=death) donors. CONCLUSION In our experience, it is possible to increase the cardiac donor pool by accepting allografts from donors, preferably female, > or =60 years of age in selected cases without a coronary angiogram, if hemodynamic parameters are in a normal range on mild-to-moderate inotropic support. We do not recommend cardiac allografts from donors > or =60 if there are signs of coronary insufficiency in the electrocardiogram, if left ventricle filling pressures are above normal on mild-to-moderate inotropic support and optimum hemodynamic management, or if there are signs of segmental dysfunction or mitral insufficiency >I in the echocardiogram.
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Affiliation(s)
- G Tenderich
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
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Körner MM, Tenderich G, Mannebach H, Minami K, Baller D, Wlost S, Gromzik H, Kleesiek K, Petzoldt R, Körfer R. Extended donor criteria: current donors with a history of prolonged insulin-dependent diabetes mellitus. Transplant Proc 1997; 29:3664-6. [PMID: 9414881 DOI: 10.1016/s0041-1345(97)01065-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- M M Körner
- Heart Center North Rhine-Westphalia, Bad Oeynhausen, Germany
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28
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Jacobbi LM, McBride V, Like K, Rose D. Increasing the donor pool: recovery of hearts from older donors. Transplant Proc 1997; 29:3297-8. [PMID: 9414721 DOI: 10.1016/s0041-1345(97)00917-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- L M Jacobbi
- Louisiana Organ Procurement Agency, Metairie, USA
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