Contraindications to Solid Organ Donation
18/2/11
ANZICS Statement on Death and Organ Donation – v3.1 (2010)
TSANZ Consensus Statement on Eligibility Criteria and Allocations Protocols – June 2010
- 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
- active HIV
- CJD
- metastatic or non-curable malignant disease
- uncontrolled infection (donor sepsis)
- 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)
-
localised tumours (kidney, prostate)
past malignancy and a long cancer free interval (childhood leukaemia, lymphoma)
treated infections (bacterial, hepatitis B or C, viral hepatitis, risk factors for HIV)
acute renal failure
HT
DM
elderly (donations have taken place from patients in early 80’s)
ORGAN SPECIFIC REQUIREMENTS
- the following are generally applied principles
- any doubt should be discussed with Transplant co-ordination
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
-
5-65 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
Jeremy Fernando (2011)
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
Jeremy Fernando (2011)