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Characterization and Application of Passive Samplers for Monitoring of Pesticides in Water
Published on: August 3, 2016
Pesticide-Poisoned Patients: Can They Be Used as Potential Organ Donors?
Umesh Mistry1, Paul I Dargan1,2,3, David M Wood4,5,6,7
1General Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Introduction:
The gap between the number of patients on transplant waiting lists and patients receiving transplants is growing. Use of organs from donors who have died following pesticide exposure remains controversial. This study reviews the literature related to transplantation from this group.
Methods:
A literature search was undertaken on PubMed using the following keywords: 'insecticide', 'pesticide', 'rodenticide', 'organophosphate', 'carbamate', 'paraquat', 'poisoning', 'toxicity', 'overdose', 'intoxication', 'ingestion', 'organ donation or procurement', 'transplant', 'allograft transplant', and 'expanded criteria organ donation'; 21 specific pesticides/insecticides were also added to the search; the indexes for EAPCCT/NACCT meeting abstracts 2008-2017 were also searched. Identified publications were reviewed and if described human donation/transplantation of ≥ 1 solid organ(s), the following was extracted: (i) compound(s) ingested; (ii) donor demographics; (iii) organ(s) transplanted; and (iv) graft function at follow-up.
Results:
Ten papers were identified describing 20 fatalities (1999-2017) related to the following pesticide exposures: organophosphate, 8 cases; aldicarb, 4; paraquat, 3; parathion, 1; malathion, 1; carbofuran/carbamate, 1; carbamate, 1; and brodifacoum, 1 and no further cases were identified from EAPCCT/NACCT abstracts. Donors were aged 12-50 (25.9 ± 11.9) years. Forty-four organs were transplanted: 28 kidneys, 7 livers, 6 corneas, and 3 hearts. Forty recipients had outcome reported: 3 (7.5%) patients died, 3 (7.5%) had graft failure/dysfunction and 34 (85.0%) had good graft function. Overall survival with good function was 96%, 71%, 83%, and 67% for kidneys, livers, corneas and hearts respectively.
Conclusion:
Review of the published literature suggests that solid organ donation following exposure to a pesticide is associated with good short-to-medium-term graft organ function following transplantation, particularly for transplanted kidneys and corneas.
Insights
Organ donation after pesticide exposure is a viable option, with most transplants showing good function. Kidneys and corneas demonstrate particularly strong outcomes in this organ donation group.
Area of Science:
- Transplantation immunology
- Toxicology
- Organ donation
Background:
- The demand for transplant organs exceeds availability, necessitating the consideration of expanded criteria donors.
- The safety and efficacy of using organs from donors with a history of pesticide exposure remain a significant concern in transplantation medicine.
Purpose of the Study:
- To review the existing literature on solid organ transplantation from donors who died following pesticide exposure.
- To evaluate the outcomes of transplanted organs from this donor group.
Main Methods:
- A comprehensive literature search was conducted on PubMed using keywords related to pesticides, toxicity, organ donation, and transplantation.
- Publications describing human solid organ donation and transplantation following pesticide ingestion were reviewed.
- Data extracted included ingested compounds, donor demographics, transplanted organs, and graft function at follow-up.
Main Results:
- Twenty fatalities from pesticide exposure (organophosphate, aldicarb, paraquat, etc.) were identified between 1999 and 2017.
- Forty-four organs (28 kidneys, 7 livers, 6 corneas, 3 hearts) were transplanted from these donors.
- Overall graft survival with good function was high, particularly for kidneys (96%) and corneas (83%).
Conclusions:
- Solid organ transplantation from donors with a history of pesticide exposure is associated with favorable short-to-medium-term graft function.
- Kidneys and corneas appear to be particularly suitable for transplantation in this context.
- This review supports the consideration of pesticide-exposed donors for organ procurement to address organ shortages.
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