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

  • Umesh Mistry
  • Paul I. Dargan
  • David M. Wood
Original Article

Abstract

Introduction

The gap between the number of patients on transplant waiting lists and patients receiving transplants is growing. Use of organs from donors who have died following pesticide exposure remains controversial. This study reviews the literature related to transplantation from this group.

Methods

A literature search was undertaken on PubMed using the following keywords: ‘insecticide’, ‘pesticide’, ‘rodenticide’, ‘organophosphate’, ‘carbamate’, ‘paraquat’, ‘poisoning’, ‘toxicity’, ‘overdose’, ‘intoxication’, ‘ingestion’, ‘organ donation or procurement’, ‘transplant’, ‘allograft transplant’, and ‘expanded criteria organ donation’; 21 specific pesticides/insecticides were also added to the search; the indexes for EAPCCT/NACCT meeting abstracts 2008–2017 were also searched. Identified publications were reviewed and if described human donation/transplantation of ≥ 1 solid organ(s), the following was extracted: (i) compound(s) ingested; (ii) donor demographics; (iii) organ(s) transplanted; and (iv) graft function at follow-up.

Results

Ten papers were identified describing 20 fatalities (1999–2017) related to the following pesticide exposures: organophosphate, 8 cases; aldicarb, 4; paraquat, 3; parathion, 1; malathion, 1; carbofuran/carbamate, 1; carbamate, 1; and brodifacoum, 1 and no further cases were identified from EAPCCT/NACCT abstracts. Donors were aged 12–50 (25.9 ± 11.9) years. Forty-four organs were transplanted: 28 kidneys, 7 livers, 6 corneas, and 3 hearts. Forty recipients had outcome reported: 3 (7.5%) patients died, 3 (7.5%) had graft failure/dysfunction and 34 (85.0%) had good graft function. Overall survival with good function was 96%, 71%, 83%, and 67% for kidneys, livers, corneas and hearts respectively.

Conclusion

Review of the published literature suggests that solid organ donation following exposure to a pesticide is associated with good short-to-medium-term graft organ function following transplantation, particularly for transplanted kidneys and corneas.

Keywords

Organ transplantation Pesticides Insecticides Poisoning 

Notes

Compliance with Ethical Standards

Conflict of Interest

None

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Copyright information

© American College of Medical Toxicology 2018

Authors and Affiliations

  1. 1.General Medicine, Guy’s and St Thomas’ NHS Foundation TrustLondonUK
  2. 2.Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation TrustLondonUK
  3. 3.Faculty of Life Sciences and MedicineKing’s College LondonLondonUK
  4. 4.Medical Toxicology OfficeLondonUK

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