title: Use of hearts transplanted from donors with severe sepsis and infectious deaths.
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.
authors.affiliation: David Geffen School of Medicine, University of California at Los Angeles, USA. bkubak@mednet.ucla.edu
authors.forename: Bernard M
authors.initials: BM
authors.lastname: Kubak
authors.forename: Aric L
authors.initials: AL
authors.lastname: Gregson
authors.forename: David A
authors.initials: DA
authors.lastname: Pegues
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Leibowitz
authors.forename: Magrit
authors.initials: M
authors.lastname: Carlson
authors.forename: Daniel
authors.initials: D
authors.lastname: Marelli
authors.forename: Jignesh
authors.initials: J
authors.lastname: Patel
authors.forename: Hillel
authors.initials: H
authors.lastname: Laks
authors.forename: Jon A
authors.initials: JA
authors.lastname: Kobashigawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018805:Sepsis; D012720:Severity of Illness Index; D014019:Tissue Donors; D055815:Young Adult