This donor was a young trauma patient in which peritoneal contamination had occurred following a gunshot wound. Herein, the first successful report of a case involving liver transplantation using a liver allograft procured from a deceased donor with an open abdomen is outlined. There are no specific recommendations regarding organ utilization from these donors, but they might be an unexplored source able to attenuate organ shortage. Organs from deceased donors with traumatic abdominal injury, peritoneal contamination and open abdomen are usually discarded due to risks of transmission of severe infections to the recipient. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons. The safe use of organs from donors with multidrug-resistant bacteria requires intra- and inter-institutional communication to allow appropriate management and prompt treatment of recipients in order to avoid transmission of infection. Transmission did not occur in high-risk recipients who received appropriate and prompt antibiotic therapy for at least 7 days. These recipients received late, short or inappropriate posttransplant antibiotic therapy. Proven transmission occurred in 4 of the 14 high-risk recipients because donor infection was either not recognized, underestimated, or not communicated. The remaining 16/30 (53%) recipients received an organ from a nonbacteremic donor with colonization of a nontransplanted organ and were considered at low risk of infection transmission. Among them, 14/30 recipients (47%) received a transplant from a donor with bacteremia or with infection/colonization of the transplanted organ and were considered at high risk of donor-derived infection transmission. In a 2-year period, 30/214 (14%) recipients received an organ from 18/170 (10.5%) deceased donors with infection or colonization caused by a carbapenem-resistant gram-negative bacteria that was unknown at the time of transplantation. This case illustrates the potential infectious risk associated with organs from donors with an OA, and suggests that aggressive surveillance for occult infections should be pursued.ĭonor-derived infections due to multidrug-resistant bacteria are a growing problem in solid organ transplantation, and optimal management options are not clear. Although 2 of the recipients died, mortality did not appear to be clearly associated with the donor-derived infections. Appropriate antibiotic coverage was initiated in all of the patients. aeruginosa, which appeared to be donor-derived with similar resistance patterns. All 4 transplant recipients subsequently developed infections with MDR P. Peritoneal swab cultures performed at the time of organ recovery grew out MDR Pseudomonas aeruginosa on the day after procurement, subsequently followed by positive blood and sputum cultures as well.
A multiorgan procurement was performed with respective transplantation of the procured organs (heart, liver, and both kidneys) into 4 separate recipients. The donor subsequently suffered brain death, and the family consented to organ donation. Herein, we report a case of a 21-year-old donor who had sustained a gunshot wound to his abdomen, resulting in a damage-control laparotomy and abdominal packing. No recommendations have been established for utilization of organs from these OA donors, because data are limited. There exists a concern for the potential of a higher risk for both bacterial and fungal infections, including multidrug-resistant (MDR) pathogens because of the prevalence of antibiotic use and critical illness in this population. The donor with this "open abdomen" (OA) presents a situation in which the risk of organ utilization is difficult to quantify. A large percentage of deceased organ donors have been subjected to traumatic injuries, which can often result in intervention that leads to abdominal packing and intensive care unit resuscitation. The organ shortage has led to relaxation of historic contraindications to organ donation.
In solid organ transplantation, the disparity between donor supply and patients awaiting transplant continues to increase.
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