Contraindications to Solid Organ Donation

OVERVIEW

Key terms

• DBD = donation after brain death
• DCD = donation after cardiac death
• WIT = time from treatment withdrawal until cold perfusion (most important phase = when SBP < 60mmHg)

ABSOLUTE

‘CHUMP’

• CJD
• active HIV
• uncontrolled infection (donor sepsis)
• metastatic or non-curable malignant disease
• Past history of malignancy that poses risk for transmission no matter how long the apparent disease-free period (e.g. melanoma, choriocarcinoma)

NOT CONTRAINDICATIONS (need to be risk assessed)

LIP-HEAD

• localised tumours (kidney, prostate)
• treated infections (bacterial, hepatitis B or C, viral hepatitis, risk factors for HIV)
• past malignancy and a long cancer free interval (childhood leukaemia, lymphoma)
• hypertension
• elderly (donations have taken place from patients in early 80’s)
• acute renal failure
• diabetes mellitus

ORGAN SPECIFIC REQUIREMENTS

• the following are generally applied principles
• whether an organ will be accepted depends on the risk-benefit balance and the needs of the next patient on the recipient list
•  any doubts should be discussed with Transplant Co-ordinator

Heart

• required to be DBD
• < 50 years old
• no significant cardiac disease
• not dependent on high dose inotropes (< 0.2mcg/kg/min noradrenaline)
• LVEF > 50%

Lung

• 5-70 years
• no significant lung disease
• P:F ratio > 250 (FiO2 1.0 and PEEP 5)
• WIT < 90 min
• no known significant pleural disease for DCD lung donation

Pancreas

• 3-45 years
• no DM
• no pancreatic tumour
• no alcoholism
• no chronic pancreatitis
• WIT < 30 min

Liver

• WIT < 30 min
• blood group matched

Kidney

• WIT < 60 min
• blood group matched

Intestinal

• age < 55
• ABO identical to recipient
• limited inotrope dose
• stable haemodynamics
• EBV and CMV negative or matched to recipient
• reasonable size match
• satisfactory macroscopic appearance of organs to be transplanted

References and Links

• ANZICS Statement on Death and Organ Donation – 3.2 (2013)