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


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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