Effect of posttraumatic donor's disseminated intravascular coagulation in intrathoracic organ donation and transplantation.
BACKGROUND
Our aim was to evaluate the influence on yield and function of intrathoracic organs from donors after severe cranial trauma complicated by disseminated intravascular coagulation (DIC).


METHODS
This retrospective observational study in a patient cohort with severe cranial trauma reading to brain death compared the number of harvested thoracic organs among individuals with versus without previous DIC. We examined exclusions for organ donation and their probable relationship to DIC. We also analyzed blood components transfused to normalize coagulation parameters. The organ recipients were followed for 1 month to detect acute graft failure.


RESULTS
Among 147 organ donors, 37 were brain dead after suffering severe cranial trauma and 13 met DIC criteria upon admission. We did not observe demographic differences among donors, although there was a trend for DIC donors to be younger (32 +/- 10 vs 40 +/- 21 years old; P = .11). Twenty-eight donors (12 with DIC and 16 without) and 29 donors (13 with DIC and 16 without) met age and medical criteria for potential heart or lung donation, respectively. Donation exclusion was related to trauma instead of DIC itself. We did not find any difference among the number of cardiac and lung organs harvested from organ donors with DIC (67% and 31%, respectively) or without DIC (75% and 44%, respectively). All DIC donors had clinical bleeding and received multiple units of blood products. Organs were harvested 37 +/- 23 (13 to 80) hours after admission. All patients had normalized coagulation parameters at surgery. In the postoperative evolution, none of the cardiac or lung recipients from DIC donors met primary graft failure criteria.


CONCLUSIONS
We concluded that hearts and lungs from donors with previous DIC were suitable for transplant recipients.
Valdivia
M
M
Department of Intensive Care, Hospital Universitario Puerta de Hierro, Madrid, Spain. valdivia1976@hotmail.com
Chamorro
C
C
Romera
M A
MA
Balandín
B
B
Pérez
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001926:Brain Death; D001930:Brain Injuries / Q000473:pathology; D004211:Disseminated Intravascular Coagulation / Q000150:complications* / Q000453:epidemiology; D016027:Heart Transplantation / Q000473:pathology*; D006801:Humans; D016040:Lung Transplantation / Q000473:pathology*; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome