Xenobiotics can cause brain death due to the unique vulnerabilities of the central nervous system. With supportive care, however, such patients may be suitable candidates for organ donation.9,10,31,38 Early identification of potential donors is critical because the viability of transplantable tissue diminishes as duration from the time of brain or cardiac death prolongs.26,38 Timely identification may be further complicated by the presence of xenobiotics that mimic brain death.4,10,36
A variety of protocols to establish brain death are reviewed elsewhere.4,10,36 Once brain death is established, organ procurement personnel assist in obtaining familial consent, deciding which organs are most suitable for transplant, and maximizing physiological support and perfusion until organ procurement occurs.38 The protocols following controlled or uncontrolled donation after cardiac arrest are socially complicated and practiced extensively in Europe.35
Successful transplantation of organs is reported from poisoned donors associated with a variety of xenobiotics1,2,5,7,9,10,12,16,25,29,30,31,32,33, and 34, 37 (Tables SC2–1 and SC2–2). Although some xenobiotics are highly toxic, such as cyanide and carbon monoxide (CO), transfer of clinical poisoning to the organ recipient is not reported. This is likely caused by several factors, including xenobiotic metabolism, tissue redistribution or binding prior to procurement, as well as the means of handling organs during the transplantation process. For example, some xenobiotic clearance may occur in the myocardium during organ rinsing and cardiopulmonary bypass.29 Furthermore, individual organs may not uniformly manifest toxicity in response to xenobiotic insults. For example, the heart of a CO poisoned donor was examined after a transplantation failed for technical reasons. The myocardium did not demonstrate histological signs of CO poisoning.34 A comprehensive review with organ-specific procurement recommendations post–carbon monoxide poisoning is presented elsewhere.3
TABLE SC2–1.Organs Transplanted after Donor Poisonings |Favorite Table|Download (.pdf) TABLE SC2–1. Organs Transplanted after Donor Poisonings
|Organ ||Xenobiotics Identified in Donors |
|Corneaa,1,23,25,26,29 ||Brodifacoum, cyanide |
|Heart8,14,25,28,30 ||Acetaminophen, β-adrenergic antagonists, alkylphosphate, benzodiazepines, brodifacoum, carbamazepine, carbon monoxide, chlormethiazole, cyanide, digitalis, digoxin, ethanol, glibenclamide, insulin, meprobamate, methanol, propoxyphene, thiocyanate |
|Kidneya,2,4,6,10,25,26,29 ||Acetaminophen, brodifacoum, carbon monoxide, Conium maculatum, cyanide, ethylene glycol, insulin, malathion, methanol, tricyclic antidepressants |
|Liver4,6,7,10,14 ||Brodifacoum, carbon monoxide, Conium maculatum, cyanide, ethylene glycol, insulin, malathion, methanol, methaqualone, tricylic antidepressants |
|Lung6,7,14,25,27,29 ||Brodifacoum, carbon monoxide, methanol |
|Pancreas6,7,10,25 ||Acetaminophen, brodifacoum, ...|
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