Abstract
BACKGROUND: The reluctance to use organs from donors who have died
from severe infections is based on the potential transmission of
an infectious agent to the recipient and on the uncertainty about
allograft function in the setting of severe donor sepsis. METHODS:
From 1999 to 2007, donor hospital records were reviewed which focused
on microbiology cultures and sensitivity results; type and duration
of antimicrobial therapy; hemodynamic data, results of echocardiogram,
and imaging studies. Preliminary positive and negative results from
pre-harvest blood, respiratory, urine, and cerebrospinal fluid cultures
were verified with the procurement agency. The harvesting surgeon
performed gross inspection of donor valvular structures. RESULTS:
Nine donor hearts were transplanted from patients who expired from
community onset infections with severe septic shock, meningitis,
and/or pneumonia caused by Streptococcus pneumoniae (n = 4), Streptococcus
milleri (n = 2), Neisseria meningitidis (n = 2), and unidentified
gram- positive cocci (n = 1). Four donors had probable infection-induced
intracranial hemorrhage, and all donors were vasopressor-dependent
before organ procurement. No evidence of donor-transmitted infection,
sepsis, or rejection was observed, and long-term function remained
excellent; allograft dysfunction in three patients resolved after
transplant. Our series of nine donors represents approximately 1.3%
of successfully transplanted cardiac allografts during the respective
period of review. CONCLUSIONS: Patients succumbing to severe infections
(meningitis, pneumonia, and septic shock) should not be arbitrarily
excluded for possible heart donation. Assessing the suitability of
donors with severe infections requires flawless communication between
the donor and transplant facility, including a comprehensive evaluation
of donor infection and pathogen(s), severity of sepsis, adequacy
of antimicrobial treatment, and the degree of sepsis-induced myocardial
dysfunction.
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