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Successful cardiac transplantation with methanol or carbon monoxide-poisoned donors
M J Bentley1, J C Mullen, S R Lopushinsky
1Division of Cardiothoracic Surgery, The University of Alberta, Edmonton, Canada.
Background:
Patients succumbing to methanol or carbon monoxide poisoning are usually rejected for heart donation. Increasing demand for donors has lead to the expansion of acceptance criteria and increased use of the marginal donor.
Methods:
We transplanted hearts from donors who had had methanol intoxication in three cases and carbon monoxide exposure in two cases. Standard donor evaluation criteria and transplantation techniques were used.
Results:
All of the transplants were successful. Three of the recipients required significant inotropic support for a few days postoperatively; however, all of the hearts functioned well over the intermediate and long term. Two recipients (1 from each group) died of complications other than heart failure (1.5 and 2 years postoperatively).
Conclusions:
Successful heart transplantation can be achieved using the hearts from patients succumbing to methanol or carbon monoxide poisoning. Routine evaluation of cardiac function and myocardial damage is adequate for screening these donors. Hearts from methanol-poisoning victims may require longer inotropic support postoperatively before complete recovery, but can provide excellent long-term function and results.
Insights
Successful heart transplants are possible using organs from donors with methanol or carbon monoxide poisoning. Standard evaluations adequately screen these marginal donors for heart transplantation, ensuring good long-term outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Toxicology
Background:
- Increasing demand for heart donors necessitates expanding acceptance criteria.
- Marginal donors, previously excluded, are increasingly utilized in heart transplantation.
- Donors succumbing to methanol or carbon monoxide poisoning are typically rejected for heart donation.
Observation:
- Five heart transplantations were performed using hearts from donors with methanol intoxication (3 cases) or carbon monoxide exposure (2 cases).
- Standard donor evaluation protocols and transplantation techniques were employed.
- Allografts were assessed for cardiac function and myocardial damage.
Findings:
- All five heart transplantations were technically successful, with allografts demonstrating good intermediate and long-term function.
- Three recipients required temporary inotropic support postoperatively.
- Two recipients (one from each donor group) died from non-cardiac complications at 1.5 and 2 years post-transplantation.
Implications:
- Hearts from donors with methanol or carbon monoxide poisoning are viable for transplantation.
- Routine cardiac evaluation is sufficient for screening these marginal donors.
- While some recipients may need extended inotropic support, these donor hearts offer excellent long-term outcomes, expanding the donor pool.