Outcome following organ removal from poisoned donors: experience with 12 cases and a review of the literature

Abstract

From 1975 to 1993, our University Hospital performed 2789 graft procedures. During the same period, 12 poisoned, “brain-dead” patients were considered as organ donors. The toxic substances involved were: methaqualone (n=1), benzodiazepine alone (n=1), benzodiazepine plus tribyclic antide-pressants (n=1), tricyclic antide-pressants alone (n=1), barbiturates (n=2), insulin (n=2), carbon monoxide (n=1), cyanide (n=1), methanol (n=1), and acetaminophen (n=1). From these intoxicated persons, 32 organ transplants were obtained, but only 23 could be followed for 1 month and only 20 for 1 year. The outcome at 1 month was favorable in 20 of the 23 patients. Two heart transplant patients died within 24 h after grafting from stroke and acute heart failure, respectively. Preoperative hepatic encephalopathy was not corrected after grafting and was directly responsible for the death of a liver transplant patient. After 1 year, 15 of the 20 recipients were still alive. Chronic hepatic graft rejection led to a fatal outcome in one recipient and to second grafting in amother. Finally, one recipient died from delayed neoplasia. Based on our experience, organ procurement may be considered in a few select cases of acute poisoning. Attention should, however, be drawn to possible graft damage due to some poisons.