Improved outcome with organs from carbon monoxide poisoned donors for intrathoracic transplantation

Background. The success of intrathoracic organ transplantation has lead to a growing imbalance between the demand and supply of donor organs. Accordin gly, there has been an expansion in the use of organs from nonconventional donors such as those who died from carbon monoxide poisoning. We describe o ur experience with 7 patients who were transplanted using organs after fata l carbon monoxide poisoning. Methods. A retrospective study of the 1,312 intrathoracic organ transplants between January 1979 and February 2000 was completed. Seven of these trans plants (0.5%) were fulfilled with organs retrieved from donors after fatal carbon monoxide poisoning. There were six heart transplants and one single lung transplant. The history of carbon monoxide inhalation was obtained in all of these donors. Results. Five of 6 patients with heart transplant are alive and well with s urvival ranging from 68 to 1,879 days (mean, 969 +/- 823 days). One patient (a 29-year-old male) died 12 hours posttransplant caused by donor organ fa ilure. The patient who had a right single lung transplant did well initiall y after the transplant, but died after 8 months caused by Pneumocystis cari nii pneumonia. All those recipients who were transplanted from carbon monox ide poisoned donors and ventilated for more than 36 hours, survived for mor e than 30 days. Moreover, these donors were assessed and optimized by the P apworth donor management protocol. Conclusions. Carbon monoxide poisoned organs can be considered for intratho racic transplantation. In view of the significant risk of donor organ failu re, a cautious approach is still warranted. Ideally, the donor should be he modynamically stable for at least 36 hours from the time of poisoning and o n minimal support. A formal approach of invasive monitoring and active mana gement further improves the chances of successful outcome. (C) 2001 by The Society of Thoracic Surgeons.