OUTCOME FOLLOWING ORGAN REMOVAL FROM POISONED DONORS - EXPERIENCE WITH 12 CASES AND A REVIEW OF THE LITERATURE

From 1975 to 1993, our University Hospital performed 2789 graft procedures. During the same period, 12 poisoned, ''brain-dead'' patients were considered as organ donors. The toxic substances involved were: methaqualone (n = 1), benzodiazepine alone (n = 1), benzodiazepine plus tricyclic antidepressants (n = 1), tricyclic antidepressants alone (n = 1), barbiturates (n = 2), insulin (n = 2), carbon mon oxide (n = 1), cyanide (n = 1), methanol (n = 1), and acetaminophen (n = 1). From these intoxicated persons, 32 organ transplants were obtained, but only 23 could be followed for 1 month and only 20 for 1 pear, The outcome at 1 month was favorable in 20 of the 23 patients. Two heart transplant patients died within 24 h after grafting from stroke and acute heart failure, respectively. Preoperative hepatic encephalopathy was not corrected after grafting and was directly responsible for the death of a liver transplant patient. After 1 year, 15 of the 20 recipients were still alive. Chronic hepatic graft rejection led to a fatal outcome in one recipient and to second grafting in another. Finally, one recipient died from delayed neoplasia. Based on our experience, organ procurement may be considered in a few select cases of acute poisoning. Attention should, however, be drawn to possible graft damage due to some poisons.