Fat and bone marrow embolization in a donor as the cause of death in a lung recipient

The cause of death in organ donors may have a great impact on organ recipient outcomes. Trauma is the prevailing cause of death among brain-dead patients in Iran and many other countries. Such patients may have many complications, among them vascular embolization with fat and other tissues. We have described herein a case of vascular embolization in a donor and its consequence on the recipient's outcome. The recipient was a 36-year-old woman with pulmonary fibrosis, who received a single lung transplant from a patient brain dead due to trauma. Donor had no obvious fractures; the oxygen challenge test was ideal. The harvested lung was normal upon bronchoscopy and it was clear on plain chest radiography. The day after lung transplantation, the recipient was extubated successfully with normal O(2) saturation. On computed tomography scan, there was a fixed infiltration at the base of the transplanted lung. On day 5 posttransplantation, the infiltrate expanded and the patient developed acute respiratory distress syndrome (ARDS). The patient's condition deteriorated rapidly and she expired on day 10 posttransplantation due to ARDS. The pathologic examination of the brain-dead patient, which was obtained from another patient's lung, was available after our recipient's death, showed massive vascular fat and bone marrow embolization. In the mentioned case, all criteria for lung harvest from the brain-dead patient were met. Looking for embolization is not among the criteria for lung transplantation if chest radiography is clear and O(2) challenge test is acceptable, but we observed a poor recipient outcome due to bone and fat embolization in the donor's lung. When transplanting from a traumatic patients, such complications should be kept in mind.