Use of grafts procured from organ transplant recipients

Background. Massive intracerebral bleeding may cause brain stem death in tr ansplant (Tx) recipients early or late postTx. We addressed the question as to whether Tx recipients may safely be used as organ donors. In particular , it is feared that exposure to immunosuppressive drugs may render those or gans unsuitable for Tx. Methods. We reviewed two case reports of liver graf ts procured from Tx patients. In addition, we conducted a survey within Uni ted Kingdom Transplant Support Service Authority (UKTSSA) to delineate the UK experience in that area, Results. Donor 1 was an 50-year-old heart Tx re cipient who became brain stem dead due to cerebral bleeding 8 months postTx . His liver was used in an 55-year-old patient with PBC who is alive and we ll more than 22 months postTx. Donor 2 was a aa-year-old kidney Tx patient who developed cerebral bleeding 4 years postTx, His liver was used in a 65- year-old patient with PBC who is doing well more than 27 months postTx. Dur ing the study period of 1989-1995, 13 organs (9 kidneys, 3 hearts, 1 liver) were procured from 6 brain stem dead Tx patients (3 long, 2 heart, and 1 k idney Tx patients). Seven recipients are enjoying satisfactory graft functi on 1 to 7 years postTx; one kidney Tx recipient was relisted 4 years postTx due to chronic rejection; five functionning grafts were lost to patient de ath; primary nonfunction was seen in one heart Tx recipient. Conclusions. T x patients can be successfully used as organ donors. In particular, chronic exposure to immunosuppression is not per se a contraindication to donation . Tx physicians confronted with the rare and tragic event of brain stem dea th in a Tx patient should not a priori exclude these patients from donation .