Use of hearts transplanted from donors with severe sepsis and infectious deaths.
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.
Kubak
Bernard M
BM
David Geffen School of Medicine, University of California at Los Angeles, USA. bkubak@mednet.ucla.edu
Gregson
Aric L
AL
Pegues
David A
DA
Leibowitz
Matthew R
MR
Carlson
Magrit
M
Marelli
Daniel
D
Patel
Jignesh
J
Laks
Hillel
H
Kobashigawa
Jon A
JA
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