Successful organ transplantation after treatment of fatal cyanide poisoning with hydroxocobalamin.
BACKGROUND
Cyanide-poisoned patients are potential organ donors provided that organs are not damaged by the poison or by antidotal treatment.


METHODS
A patient with third-degree burns and smoke inhalation-associated cyanide poisoning confirmed by measurements of whole blood cyanide was found in cardiac arrest and administered epinephrine and hydroxocobalamin (5 g + 5 g). Cardiac activity resumed, but the patient was declared brain dead on the third day of hospitalization when coma deteriorated to a shock state with refractory hypoxemia. Kidneys, heart, and liver were removed and transplanted into four patients. Gross pre-transplantation inspection of the donor organs and renal histology showed no evidence that hydroxocobalamin caused organ toxicity. Donor organs functioned normally through follow-up periods of several months.


CONCLUSIONS
Anoxic cardiac arrest following acute cyanide poisoning treated with hydroxocobalamin (5 g + 5 g) was not a contraindication to organ transplantation after confirmed encephalic death in this patient.
Fortin
J L
JL
Emergency Medical Service of the Paris Fire Brigade,Paris, France. Fortin.jeanluc@wanadoo.fr
Ruttimann
M
M
Capellier
G
G
Bigorie
A
A
Ferlicot
S
S
Thervet
E
E
D000931:Antidotes / Q000627:therapeutic use*; D003486:Cyanides / Q000097:blood / Q000506:poisoning*; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy; D016027:Heart Transplantation; D006801:Humans; D006879:Hydroxocobalamin / Q000627:therapeutic use*; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors
D000931:Antidotes; D003486:Cyanides; D006879:Hydroxocobalamin