EXTENDED DONOR CRITERIA - USE OF CARDIAC ALLOGRAFTS AFTER CARBON-MONOXIDE POISONING

Background. An increasing demand for cardiac allografts for the treatm ent of end-stage cardiac failure has led to a shift in the traditional views about donor criteria. The use of allografts exposed to high con centrations of carbon monoxide is still under discussion. The current literature on this topic is contradictory. We describe our experience with orthotopic cardiac transplantation, using cardiac allografts afte r carbon monoxide poisoning. Methods. Between March 13, 1989 and Augus t 1, 1996, 770 orthotopic heart transplantations were performed in our center. Within this period, we accepted five cardiac allografts from brain-dead, carbon monoxide-poisoned donors. Donor history showed carb on monoxide intoxication in all cases. At the time of organ explantati on, donor hemodynamic parameters were feeble in all patients. Results. The postoperative course was uneventful in three of the five recipien ts, The overall 3-year survival rate in this small group is 40%. Induc tion therapy or rescue therapy with mono/polyclonal antibodies was not necessary. Myocardial right-ventricular biopsies did not show any spe cific signs of carbon monoxide poisoning. Conclusions. In our opinion, cardiac allografts from donors exposed to carbon monoxide can be tran splanted successfully in infants and adults, if there are no signs of severe hemodynamic dysfunction in the presence of a normal central ven ous pressure and low-dose support with catecholamines and there are no electrocardiographic changes in combination with elevated transaminas e. With extended donor criteria, the hearts of carbon monoxide-poisone d victims could increase the number of suitable organs and lower the d eath rate of patients on the United Network for Organ Sharing and Euro transplant International Foundation waiting lists.