Successfully transplanted liver procured from a carbamate insecticide-poisoned donor: Is acute intoxication an obstacle to organ retrieval?

Abstract

One of the major limitations in organ transplantation is the lack of suitable donors. As the demand for suitable organs exceeds the supply, identification of potential donors continues to evolve. Due to perceived risks of transmittable toxins and insufficient understanding of toxicological fate, poisoned patients are often overlooked as organ donors. A 16-year-old female attempted suicide with a poison. She was immediately transported to a state hospital and underwent cardiopulmonary resuscitation. The patient exhibited symptoms consistent with cholinergic poisoning and remained comatose. Diagnosis of brain death was confirmed three weeks after admission to the intensive care unit. The parents agreed to donate the organs of their daughter. After reviewing of the available literature on the disposition and fate of pesticides in human tissues and comparing notes with medical toxicologists, we decided to harvest the patient's liver for transplantation. The liver was transplanted to a 36-year-old female suffering from chronic hepatitis B-induced liver cirrhosis. The recipient was well completely two years posttransplantation to the best of our knowledge, this is the first case ever reported of liver transplantation from a carbamate insecticide-poisoned donor. This case of successful liver transplantation from a pesticide-poisoned donor underscores the fact that poisoned patients should not be overlooked as organ donors. The decision to harvest the patient's organs should be made jointly by medical toxicologists and transplant team after careful evaluation of available data and the lack of clinical toxicity.